Jenkins et al.: DIFFICULT AIRWAY MANAGEMENT IN CANADA
851
agement issues have become increasingly important.
In 1998 Rosenblatt et al. surveyed 472 ASA members
to determine current practice patterns in the United
States.3 Following publication of a review with recom-
mendations on management of the unanticipated dif-
ficult airway by the Canadian Airway Focus Group
(CAFG) in 1998,4 we wished to assess current anes-
thesia practice, training and equipment availability for
the difficult airway among Canadian anesthesiologists.
tion included: asleep, iv; asleep, inhalational; or
awake/local. Choices of airway equipment included:
direct laryngoscope, fibreoptic bronchoscope (FOB),
lighted stylet, intubating LMA, rigid fibreoptic scope
e.g., “Bullard”, and surgical airway. Other techniques
(to be specified) included nasal intubation, rigid bron-
choscopy and retrograde wire.
The second section was designed to assess the avail-
ability of these and other airway devices and a difficult
intubation cart in the respondent’s workplace. In the
third section demographic variables including age,
gender, years in practice, region of practice and type of
hospital practice were assessed. Respondents were
asked whether they had attended a difficult airway
course within the preceding five years and if they had
opportunity to practice airway skills on a mannequin
during residency.
Surveys were mailed in March 2000. Data were
entered into Microsoft Excel 97 (Redmond, WA, USA)
and analyzed using Statistical Package for Social
Sciences (SPSS, version 10.0.7 for Windows, Chicago,
IL, USA). Demographic data were categorized as fol-
lows: age: less than 45 yr and 45 yr or greater; years in
practice: less than 20 yr and 20 yr or greater experience;
community or teaching hospitals; four geographical
regions: Western provinces (British Columbia,
Northwest Territories, Alberta, Saskatchewan,
Manitoba), Ontario, Quebec and Atlantic Provinces
(New Brunswick, Nova Scotia, Newfoundland and
Prince Edward Island). The age and years in practice
cutpoints were either derived arbitrarily or based on
results from the ASA survey of difficult airway manage-
ment.3 Surveys with more than one response in induc-
tion and intubating choices were eliminated from
analysis. Comparison of categorical variables among
and between groups and subgroups were performed
using Chi squared or Fisher’s exact analyses. A P value
of < 0.05 was considered statistically significant.
Methods
Following approval from the Research Ethics Board,
University Health Network and Canadian
Anesthesiologists Society, a survey of airway manage-
ment was sent to 1702 members of the Canadian
Anesthesiologists Society. All active and resident
members were included while associate, retired, for-
eign and honorary members were excluded.
Confidentiality and anonymity were maintained but
questionnaires were number coded to identify non-
respondents. A stamped, addressed envelope was
included with each survey.
The questionnaire consisted of three sections. In
the first, each subject was presented with ten brief dif-
ficult airway scenarios involving cooperative adult
patients for elective surgery (unless specified other-
wise) who required endotracheal intubation. The
cases included:
1. Post-tonsillectomy bleeding for exploration.
2. Cervical cord compression with leg weakness
for discectomy.
3. Laryngeal tumour with stridor for laryngectomy.
4. Mediastinal mass with supine stridor.
5. Motor vehicle accident (MVA); cervical spine
not cleared; uncooperative patient; neurologi-
cally intact.
6. Laparoscopic cholecystectomy; Mallampati IV.
7. Retropharyngeal abscess for incision and
drainage; patient cannot swallow.
Results
8. Stat Cesarean section for fetal distress, “airway
looks difficult”.
Out of 1702 surveys sent, 833 were returned (49%
response rate). Demographic data are summarized in
Table I. The commonest age group of anesthesiolo-
gists was 35–44 yr old (32%). Seventy-six percent of
respondents were male and 23% female. Staff physi-
cians comprised 88% of the sample and residents the
remaining 12%. The majority of respondents worked
in teaching hospitals (60%) with the rest based in the
community. Respondents from Western, Ontario,
Quebec and Atlantic provinces accounted for 30, 41,
16 and 9% respectively. Fifty-five percent had attend-
ed a difficult airway workshop within the last five
years, and 30% had received difficult airway training
9. Closed head injury, Glasgow coma score
(GCS) 5; cervical spine x rays normal.
10. Previous anesthetic, arytenoids seen on laryn-
goscopy; three attempts before successful intu-
bation
Respondents were required to choose one induc-
tion condition and one intubation technique they
would use in each case. Choices of induction condi-
A
Caplan RA. The ASA closed claims project: leassons
learned. ASA Annual Meeting Refresher Course Lecture 2000.