Tomoyuki Saito, Yuki Mori, Naoi TSURUMACHI, Shunsuke Saima
Pulmonary aspiration remains a serious concern during general anesthesia for cesarean delivery. Although gastric tube placement after intubation has been advocated as a strategy to reduce gastric volume and aspiration risk in selected cases, blind insertion may be technically difficult in pregnant patients and is often delayed during the peri-delivery period when multiple anesthetic tasks arise simultaneously. We report the first obstetric use of a videolaryngoscope-guided gastric-tube insertion aid employing a double-insertion technique—simultaneous tracheal and gastric tube placement during rapid sequence induction—to enable immediate gastric decompression. A 38-year-old patient with placenta previa totalis underwent elective cesarean delivery under general anesthesia. Following videolaryngoscopic tracheal intubation, a gastric tube preloaded in a dedicated insertion guide was advanced under direct visualization into the esophageal inlet immediately after cuff inflation, without interrupting laryngoscopic visualization. Gastric contents were immediately aspirated. Oxygen saturation remained stable throughout the airway and gastric tube procedures. The perioperative course was uneventful despite major blood loss. This technique allowed reliable gastric decompression at the time of airway securing and may represent a useful prophylactic strategy to mitigate aspiration risk during obstetric rapid sequence induction.