PRACTICE PATTERNS IN MANAGING THE DIFFICULT AIRWAY BY ANESTHESIOLOGISTS IN THE UNITED-STATES

Despite the availability of several techniques and devices for the man agement of the difficult airway, little information has been published regarding the prevalence of their use by anesthesiologists in the Uni ted States. To determine current practice patterns, we surveyed clinic ians using a questionnaire consisting of 14 difficult airway scenarios . Anesthesiologists were requested to indicate their Likely approach t o anesthetic induction (e.g., awake but sedated, general anesthesia wi th spontaneous ventilation, general anesthesia with apnea after assuri ng a patent airway, or general anesthesia with apnea) and the primary device they would use to intubate (e.g., direct laryngoscopy [DL], fle xible fiberoptic bronchoscope [FOB], rigid fiberoptic device, surgical airway, retrograde intubation kit, laryngeal mask airway, gum elastic bougie, or Combitube(TM)). The availability of these devices was also determined tin room at all times, available ''stat,'' available if ar ranged preoperatively, or not available). The survey was mailed to 100 0 randomly chosen active members of the American Society of Anesthesio logists. Second and third surveys were mailed to nonresponders. Four h undred seventy-two completed surveys were returned. Responses by demog raphic groups were compared by using chi(2) analysis. DL and FOE-aided tracheal intubation techniques were chosen for most cases by most ane sthesiologists (P < 0.05). Anesthesiologists with >10 yr of clinical e xperience and those older than 55 yr of age preferred DL with apneic c onditions (P ( 0.05). Anesthesiologists who had attended workshops wit hin the last 5 yr had greater availability of retrograde guidewire equ ipment and FOBs (P < 0.05). There was little use of newer alternative airway devices. Implications: Although the teaching of alternative met hods of securing a difficult airway has become ubiquitous, most anesth esiologists rely on direct laryngoscopy and fiberoptic-aided intubatio n in most clinical circumstances. Although workshops in the management of the difficult airway may have resulted in increased use of the fib eroptic bronchoscope and the availability of retrograde guidewire intu bation equipment, other devices have not enjoyed such an increase.