Practice patterns in managing the difficult airway by anesthesiologists in the United States

被引:104
作者
Rosenblatt, WH
Wagner, PJ
Ovassapian, A
Kain, ZN
机构
[1] Yale Univ, Sch Med, Dept Anesthesiol, New Haven, CT 06510 USA
[2] Yale Univ, Sch Med, Dept Pediat, New Haven, CT 06510 USA
[3] Northwestern Univ, Sch Med, Dept Anesthesiol, Chicago, IL USA
关键词
D O I
10.1097/00000539-199807000-00032
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Despite the availability of several techniques and devices for the management of the difficult airway, little information has been published regarding the prevalence of their use by anesthesiologists in the United States. To determine current practice patterns, we surveyed clinicians using a questionnaire consisting of 14 difficult airway scenarios. Anesthesiologists were requested to indicate their Likely approach to anesthetic induction (e.g., awake but sedated, general anesthesia with spontaneous ventilation, general anesthesia with apnea after assuring a patent airway, or general anesthesia with apnea) and the primary device they would use to intubate (e.g., direct laryngoscopy [DL], flexible fiberoptic bronchoscope [FOB], rigid fiberoptic device, surgical airway, retrograde intubation kit, laryngeal mask airway, gum elastic bougie, or Combitube(TM)). The availability of these devices was also determined tin room at all times, available "stat," available if arranged preoperatively, or not available). The survey was mailed to 1000 randomly chosen active members of the American Society of Anesthesiologists. Second and third surveys were mailed to nonresponders. Four hundred seventy-two completed surveys were returned. Responses by demographic groups were compared by using chi(2) analysis. DL and FOE-aided tracheal intubation techniques were chosen for most cases by most anesthesiologists (P < 0.05). Anesthesiologists with >10 yr of clinical experience and those older than 55 yr of age preferred DL with apneic conditions (P ( 0.05). Anesthesiologists who had attended workshops within the last 5 yr had greater availability of retrograde guidewire equipment and FOBs (P < 0.05). There was little use of newer alternative airway devices. Implications: Although the teaching of alternative methods of securing a difficult airway has become ubiquitous, most anesthesiologists rely on direct laryngoscopy and fiberoptic-aided intubation in most clinical circumstances. Although workshops in the management of the difficult airway may have resulted in increased use of the fiberoptic bronchoscope and the availability of retrograde guidewire intubation equipment, other devices have not enjoyed such an increase.
引用
收藏
页码:153 / 157
页数:5
相关论文
共 9 条
[1]  
Brimacombe JR, 1997, The Laryngeal Mask Airway: A Review and Practical Guide
[2]   ADVERSE RESPIRATORY EVENTS IN ANESTHESIA - A CLOSED CLAIMS ANALYSIS [J].
CAPLAN, RA ;
POSNER, KL ;
WARD, RJ ;
CHENEY, FW .
ANESTHESIOLOGY, 1990, 72 (05) :828-833
[3]  
Cooper S.D., 1996, AIRWAY MANAGEMENT PR, P374
[4]   ACUTE EPIGLOTTITIS IN THE ADULT - IS INTUBATION MANDATORY [J].
CROSBY, E ;
REID, D .
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE, 1991, 38 (07) :914-918
[5]   DISSEMINATION OF FIBEROPTIC AIRWAY ENDOSCOPY SKILLS BY MEANS OF A WORKSHOP UTILIZING MODELS [J].
DYKES, MHM ;
OVASSAPIAN, A .
BRITISH JOURNAL OF ANAESTHESIA, 1989, 63 (05) :595-597
[6]   THE CLOSED CLAIMS STUDY [J].
KEATS, AS .
ANESTHESIOLOGY, 1990, 73 (02) :199-201
[7]   LEARNING FIBEROPTIC INTUBATION - USE OF SIMULATORS V TRADITIONAL TEACHING [J].
OVASSAPIAN, A ;
YELICH, SJ ;
DYKES, MHM ;
GOLMAN, ME .
BRITISH JOURNAL OF ANAESTHESIA, 1988, 61 (02) :217-220
[8]  
OVASSAPIAN A, 1991, ANESTHESIOL CLIN N A, V9, P175
[9]  
SANCHEZ A, 1996, AIRWAY MANAGEMENT PR, P320