Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?
OBJECTIVE
To determine the extent instruction and practice in the use of airway devices and techniques varies among anesthesiologists practicing in the United States.


METHODS
Survey questionnaire.


METHODS
University medical center.


METHODS
Questionnaires were completed by American-trained anesthesiologists who attended the 1999 American Society of Anesthesiologists (ASA) Annual Meeting. Data collected included demographics, education, skills with airway devices/techniques, management of clinical difficult airway scenarios, and the use of the ASA Difficult Airway Algorithm.


RESULTS
1) DEMOGRAPHICS: 452 questionnaires were correctly completed; 62% attending anesthesiologists, 70% <50 years, 81% males, 44% from academic institutions, 63% >10 years of practice, 81% night duty, 77% board certified. 2) Education: 71% had at least one educational modality: difficult airway rotation, workshops, conferences, books, and simulators. 3) Skills: Miller blade 61%, Bullard laryngoscope 32%, LMA 86%, Combitube 43%, bougie 43%, exchangers 47%, cuffed oropharyngeal airway (COPA) 34%, retrograde 41%, transtracheal needle jet ventilation 34%, cricothyrotomy 21%, fiberoptics 59%, and blind nasal intubation 78%. The average reported use of special airway devices/techniques was 47.5%. 4) Management choices: failed intubation/ventilation: LMA (81%) and for all other situations: fiberoptic intubation. Use of ASA Difficult Airway Algorithm in clinical practice (86%).


CONCLUSIONS
Fiberoptic intubation and the LMA are most popular in management of the difficult airway.
Ezri
Tiberiu
T
Department of Anesthesiology, The University of Texas-Houston Medical School, 6431 Fannin, Houston, TX 77030, USA.
Szmuk
Peter
P
Warters
R David
RD
Katz
Jeffrey
J
Hagberg
Carin A
CA
D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000776:Anesthesiology / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D014481:United States