Anticipation of the Difficult Airway
Anticipation of the Difficult Airway
Background Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration.
Methods After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery.
Results Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3% vs 84.3%, P=0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P=0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate=0.00068, P=0.031).
Conclusions The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme.
Airway management remains one of the most important responsibilities of an anaesthetist, yet documentation of the clinical assessment, which is a professional requirement, is often incomplete. Poor airway management has been recognized as a serious patient safety concern for almost three decades, highlighting the need for careful airway assessment before the induction of anaesthesia. While improvements in patient monitoring, airway devices, and clinical protocols and training have reduced the risk associated with an unpredicted difficult airway (DA), these changes have not reduced the incidence of unexpected DAs in clinical practice. Since the consequences of an unanticipated DA are potentially catastrophic, proper education and training are a continued necessity.
This study addresses this gap in knowledge by evaluating the impact of a comprehensive airway assessment form on resident education, while assessing is of questionable value. We hypothesized that a new comprehensive airway assessment form would result in greater resident recognition of the 11 important airway features recommended by the ASA. Based on this hypothesis, the overall aim of the present investigation was to document the effect of a more comprehensive airway assessment form on resident education.
Abstract and Introduction
Abstract
Background Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration.
Methods After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery.
Results Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3% vs 84.3%, P=0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P=0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate=0.00068, P=0.031).
Conclusions The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme.
Introduction
Airway management remains one of the most important responsibilities of an anaesthetist, yet documentation of the clinical assessment, which is a professional requirement, is often incomplete. Poor airway management has been recognized as a serious patient safety concern for almost three decades, highlighting the need for careful airway assessment before the induction of anaesthesia. While improvements in patient monitoring, airway devices, and clinical protocols and training have reduced the risk associated with an unpredicted difficult airway (DA), these changes have not reduced the incidence of unexpected DAs in clinical practice. Since the consequences of an unanticipated DA are potentially catastrophic, proper education and training are a continued necessity.
This study addresses this gap in knowledge by evaluating the impact of a comprehensive airway assessment form on resident education, while assessing is of questionable value. We hypothesized that a new comprehensive airway assessment form would result in greater resident recognition of the 11 important airway features recommended by the ASA. Based on this hypothesis, the overall aim of the present investigation was to document the effect of a more comprehensive airway assessment form on resident education.
