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2 results

  • Perception of training needs and opportunities in advanced airway skills: a survey of British and Irish trainees

  • A. F. McNarry, T. Dovell, F. M. L. Dancey, M. E. Pead
  • Journal:
    European Journal of Anaesthesiology / Volume 24 / Issue 6 / June 2007
    Published online by Cambridge University Press:
    01 June 2007, pp. 498-504
    Print publication:
    June 2007
  • Background and objective

    We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed).

    Methods

    Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues.

    Results

    We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10–20); the median number performed was 2 (IQR 0–4). This was statistically significant for the groups senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0–1 and 0–0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent.

    Conclusion

    Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.

  • Management of unanticipated difficult intubation: a survey of current practice in the Oxford region

  • A. Bokhari, S. W. Benham, M. T. Popat
  • Journal:
    European Journal of Anaesthesiology / Volume 21 / Issue 2 / February 2004
    Published online by Cambridge University Press:
    23 December 2004, pp. 123-127
    Print publication:
    February 2004

  • Summary

    Background and objective: Unanticipated difficulty in tracheal intubation in an anaesthetized patient has always been a cause of concern to anaesthesiologists. This difficulty may lead to morbidity and mortality. This survey was carried out to determine the technique commonly favoured in centres in the Oxford region in the UK for the management of unanticipated difficult intubation.

    Methods: We conducted a clinical scenario-based questionnaire survey of 181 anaesthesiologists in the Oxford region. In this scenario, difficulty in endotracheal intubation is recognized only after induction of anaesthesia. A number of options were available to deal with this situation. We used this scenario as a tool to gain insight into the training and the training needs of anaesthesiologists at various levels of training.

    Results: Of the 181 questionnaires sent, we received 143 (79%) completed replies. The vast majority (141/143 (99%)) of anaesthesiologists would use a gum-elastic bougie together with head and neck positioning and optimal external laryngeal manipulation to gain the best attempt at intubation. If intubation still failed, overall 129/143 (90%) had a back-up plan, while 14/143 (10%) had no plan. Flexible fibreoptic techniques were more commonly planned by 92/143 (64%) anaesthesiologists compared to blind techniques which were less commonly planned by 37/143 (26%) anaesthesiologists. Differences in choice of technique among anaesthesiologists in teaching and district general hospitals were not significant (P = 0.87). Overall, trainees were less likely to choose fibreoptic techniques compared to consultants (P = 0.0009) and would use blind techniques or ask a more experienced colleague to take over. The main reason for the choice was previous experience with the technique.

    Conclusions: Although fibreoptic techniques were most commonly planned, these were less often chosen by trainees than consultants due to lack of experience/training, while unavailability of intubating laryngeal mask airway (Intavent®) was an additional issue precluding its use as an adjunct to intubation.