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A survey of Canadian anesthesiologists’ preferences in difficult intubation and “cannot intubate, cannot ventilate” situations

  • David T. WongEmail author
  • Arpan Mehta
  • Amanda D. Tam
  • Brian Yau
  • Jean Wong
Reports of Original Investigations

Abstract

Introduction

The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and “cannot intubate, cannot ventilate” (CICV) situations.

Methods

A questionnaire was e-mailed to members of the Canadian Anesthesiologists’ Society to ascertain their preferences, experience, and comfort level with regard to their use of airway equipment in difficult intubation and CICV situations in adult patients. A Chi square test was used to analyse the data. All reported P values are two-sided.

Results

Nine hundred ninety-seven of 2,532 questionnaires (39%) were returned. In an unanticipated difficult direct laryngoscopic intubation situation, 893 of 997 (90%) respondents chose a video laryngoscope as the first-choice rescue technique, while 41 (4%) and 21 (2%) of respondents chose a flexible bronchoscope and an intubating laryngeal mask airway device, respectively. The majority of anesthesiologists had experience and were comfortable with using a flexible bronchoscope or a video laryngoscope. Regarding CICV, 294 of 955 (31%) respondents stated that they had never encountered it. Wire-guided cricothyroidotomy was chosen as the first-choice surgical airway by 375 of 955 (39%) respondents, while intravenous catheter cricothyroidotomy and “defer to tracheostomy by surgeon” were selected by 266 (28%) and 215 (23%) respondents, respectively. Seven hundred eighty-five of 997 (78%) respondents were familiar with the exact steps of the American Society of Anesthesiologists’ difficult airway algorithm, while 448 (47%) had attended an airway workshop within the past five years.

Conclusions

In a difficult intubation situation, the most frequently selected first-choice airway device was a video laryngoscope, followed by a flexible bronchoscope. In a CICV situation, the most frequently selected first-choice surgical airway technique was a wire-guided cricothyroidotomy, followed by an intravenous catheter cricothyroidotomy.

Keywords

Laryngeal Mask Airway Difficult Airway Difficult Intubation Video Laryngoscope Laryngeal Mask Airway Device 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Une enquête sur les préférences des anesthésiologistes canadiens devant des intubations difficiles et dans les situations « impossible d’intuber, impossible de ventiler »

Résumé

Introduction

L’objectif de cette enquête était de déterminer quel équipement les anesthésiologistes préfèrent en cas d’intubation trachéale difficile et dans les situations « impossible d’intuber, impossible de ventiler » (IIIV).

Méthodes

Un questionnaire a été adressé par courriel au membre de la Société canadienne des anesthésiologistes pour connaître leurs préférences, leur expérience et leur niveau de confort concernant l’utilisation du matériel d’intubation dans les cas d’intubation difficile et dans les situations IIIV chez des patients adultes. Un test du Chi2 a été utilisé pour analyser les données. Toutes les valeurs de P fournies sont bilatérales.

Résultats

Neuf cent quatre-vingt-dix-sept questionnaires ont été retournés sur 2 532 (39 %). Confrontés à une situation inattendue d’intubation laryngoscopique directe difficile, 893 des 997 (90 %) répondants ont choisi un vidéolaryngoscope comme premier choix de technique de secours, tandis que 41 (4 %) et 21 (2 %) des répondants ont préféré un bronchoscope flexible et un dispositif de masque laryngé d’intubation, respectivement. La majorité des anesthésiologistes avaient l’expérience des bronchoscopes flexibles et d’un vidéolaryngoscope et se sentaient à l’aise pour les utiliser. Concernant les situations IIIV, 294 des 955 répondants (31 %) ont indiqué qu’ils n’en avaient jamais rencontré. La cricothyroïdotomie sur guide d’acier a été retenue comme premier choix chirurgical d’ouverture des voies aériennes par 375 des 955 répondants (39 %), tandis que la cricothyroïdotomie avec cathéter intraveineux et le « transfert au chirurgien pour trachéotomie » ont été choisis par, respectivement, 266 (28 %) et 215 (23 %) des répondants. Sept cent quatre-vingt-cinq répondant sur 997 (78 %) connaissaient les étapes exactes de l’algorithme pour intubation difficile de l’American Society of Anesthesiologists tandis que 448 répondants (47 %) avaient assisté à un atelier sur les voies aériennes au cours des cinq dernières années.

Conclusions

Dans les situations d’intubation difficile, le premier choix de dispositif, le plus souvent sélectionné, et un vidéolaryngoscope, suivi par le bronchoscope flexible. Devant une situation IIIV, la technique chirurgicale de premier choix la plus souvent sélectionnée est la cricothyroïdotomie sur guide d’acier, suivie par la cricothyroïdotomie par cathéter intraveineux.

Notes

Funding sources

Supported in part by the Department of Anesthesia, University of Toronto, Canada.

Conflicts of interest

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2014

Authors and Affiliations

  • David T. Wong
    • 1
    Email author
  • Arpan Mehta
    • 1
  • Amanda D. Tam
    • 1
  • Brian Yau
    • 1
  • Jean Wong
    • 1
  1. 1.Department of Anesthesia, Toronto Western HospitalUniversity Health Network, University of TorontoTorontoCanada

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