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Randomized Controlled Trial
. 2013 Aug;111(2):276-85.
doi: 10.1093/bja/aet029. Epub 2013 Mar 6.

Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

D Cattano  1 , P V Killoran, D Iannucci, V Maddukuri, A V Altamirano, S Sridhar, C Seitan, Z Chen, C A Hagberg
Affiliations
Randomized Controlled Trial

Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

D Cattano et al. Br J Anaesth. 2013 Aug.

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.

Keywords: airway; education, medical students.

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Figures

Fig 1
Fig 1
Resident randomization. CA 1, first-year residents during first year of study; CA 2, second-year residents during first year of study; CA 3, third-year residents during first year of study; CA 1–1, first-year residents during second year of study; CA 1–2, second-year residents during second year of study; CA 2–3, third-year residents during second year of study.
Fig 2
Fig 2
Assessment distribution. DMV, difficult mask ventilation; DDL, difficult direct laryngoscopy; DI, difficult intubation; DSGA, difficult supraglottic airway; DA, difficult airway.
Fig 3
Fig 3
Thirty day moving average of prediction accuracy over duration of study. CA 1–2 are residents who enrolled as first-year residents when the study began and were second-year residents at the end of the study; CA 2–3 are residents who enrolled as second-year residents when the study began and were third-year residents at the end of the study; CA 1–1 are residents who enrolled as first-year residents the second year of the study; CA 3 are residents who enrolled as third-year residents the first year of the study.
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Comment in

  • Anticipation of the difficult airway.
    Nørskov AK, Lundstrøm LH, Wetterslev J, Rosenstock CV. Nørskov AK, et al. Br J Anaesth. 2014 Mar;112(3):589-90. doi: 10.1093/bja/aeu041. Epub 2014 Feb 4. Br J Anaesth. 2014. PMID: 24496912 No abstract available.
  • Reply from the authors.
    Cattano D, Killoran P, Hagberg CA. Cattano D, et al. Br J Anaesth. 2014 Mar;112(3):590-1. doi: 10.1093/bja/aeu040. Br J Anaesth. 2014. PMID: 24535526 No abstract available.

References

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