The 2004 Difficult Airway Society guidelines for the management of difficult tracheal intubation: revolutionary and enduring

National survey on the current status of airway management in China

Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education.

Current Status of Difficult Airway Information Dissemination at a Tertiary Pediatric Hospital

OBJECTIVE

Difficult airway is one of the most common potential risk factors for increased fatality in craniofacial/plastic surgery patients. To date, there is no well-established and all-around difficult airway notification system in China, which has recently been recommended by existing guidelines to improve the care of patients with known difficult airways. This study aimed to investigate the current status of critical information communication concerning difficult airway management in our institute.

METHODS

Vital information required to establish a difficult airway registry and notification system was collected through a literature review and expert suggestions. After approval by the Research Ethics Board, 3 online questionnaires were developed and sent to surgeons, anesthesiologists, and proxies of the patients. Knowledge of difficult airways, the willingness to be involved in the difficult airway notification system, and the way to disseminate the information were investigated in the 3 groups. The specific information that was disseminated, required, and available was investigated in the anesthesiologist group.

RESULTS

Compared with the surgeons and anesthesiologists, significantly fewer patients knew the definition of a difficult airway and thought it was a potential risk factor. There were no significant differences in the willingness to be informed of the difficulty encountered during airway management. Significant differences were detected in the willingness and way to disseminate the airway information when the participants communicated with different groups. Significantly more patients would disseminate the information to the surgeon and significantly more surgeons would disseminate the information to the patient and the other surgeon. Significantly more anesthesiologists would disseminate the information to the patient and the other anesthesiologists. A significant difference was observed between what was expected and what was available for the anesthesiologist to retrieve the airway information of a patient with known airway difficulty. Significantly more anesthesiologists would notify only the patient of the diagnosis of a difficult airway both oral and written, whereas significantly more anesthesiologists would notify the other anesthesiologist of the specific difficulties in oral only. Most participants agreed to be involved in the difficult airway notification system despite the significantly lower percentage in the patient group (89%).

CONCLUSIONS

Difficult airway information dissemination is, at the time of this writing, ineffective, which leads to a large gap between the expectation and practice of the anesthesiologist when caring for a patient with a difficult airway. Thus, a difficult airway registry and notification system should be developed, that has a solid foundation in all the participants.

Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review

Objective:

To investigate whether implementation of a multidisciplinary airway team was associated with improvement in (1) rate of successful airway securement at first attempt; (2) time to secure airway; and (3) overall complication rate in patients with a difficult airway, as compared with usual care.

Data Sources:

Ovid Medline, Embase, Scopus, Cochrane Central, and CINAHL databases.

Review Methods:

Systematic review of literature on inpatient multidisciplinary team management of difficult airways, including all studies performed in inpatient settings, excluding studies of ventilator weaning, flight/military medicine, EXIT procedures, and simulation or educational studies. DistillerSR was used for article screening and risk of a bias assessment to evaluate article quality. Data was extracted on study design, airway team composition, patient characteristics, and clinical outcomes including airway securement, complications, and mortality.

Results:

From 5323 studies screened, 19 studies met inclusion criteria with 4675 patients. Study designs included 12 quality improvement projects, 6 cohort studies, and 1 randomized controlled trial. Four studies evaluated effect of multidisciplinary difficult airway teams on airway securement; all reported higher first attempt success rate with team approach. Three studies reported time to secure the difficult airways, all reporting swifter airway securement with team approach. The most common difficult airway complications were hypoxia, esophageal intubation, hemodynamic instability, and aspiration. Team composition varied, including otolaryngologists, anesthesiologists, intensivists, nurses, and respiratory care practitioners.

Conclusion:

Multidisciplinary difficult airway teams are associated with improved clinical outcomes compared to unstructured emergency airway management; however, studies have significant heterogeneity in team composition, algorithms for airway securement, and outcomes reported. Further evidence is necessary to define the clinical efficacy, cost-effectiveness, and best practices relating to implementing difficult airway teams in inpatient settings.