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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 October;78(10):1088-94
Survey on controversies in airway management among anesthesiologists in the UK, Austria and Switzerland
Theiler L. 1, 2, Fischer H. 3, Voelke N. 2, Basciani R. 2, Hasty F. 1, Greif R. 2 ✉
1 Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA;
2 University Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland;
3 Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia, General Intensive Care and Pain Control, Medical University Vienna, Austria
BACKGROUND: While surveys about anesthesia practice appear regularly in the anesthesia literature, they are usually bound to one country. We compared the approach to specific airway management issues among anesthesiologists from three different European countries.
METHODS: A questionnaire was distributed during the main session of three anesthesia meetings in Austria (A), the UK, and Switzerland (CH). Questions concerned whether anesthesiologists routinely check for risk factors associated with difficult mask ventilation; whether anesthesiologists are used to mask ventilate prior to administering neuromuscular blocking drugs (NMBD); whether anesthesiologists apply cricoid pressure.
RESULTS: We evaluated 266 questionnaires. No significant differences in the frequency of checking predictors were found, except for “age” (UK: 28%, A: 13%, CH:11%, P=0.01). Fewer anesthesiologists from the UK always check mask ventilation before NMBD (UK: 34%, A: 72%, CH: 67%, P<0.001); but they check mask ventilation more often when risk factors are present (UK: 36%, A: 13%, CH: 20%, P=0.004). Very few anesthesiologists from the UK never apply cricoid pressure (UK: 2%, A: 40%, CH: 49%, P<0.001), but almost all of them apply it in case of rapid sequence intubation (UK: 96%, A: 52%, CH:30%, P<0.001).
CONCLUSION: Answers from anesthesiologists in the UK differed significantly from those in A and CH. Anesthesiologists in the UK check mask ventilation after induction less frequently, but they check more often when risk factors of difficult mask ventilation are present. Cricoid pressure seems to remain an important part of the rapid sequence induction technique in the UK, whereas anesthesiologists in Austria and Switzerland rely less on this technique.