Management of difficult intubation by French anaesthetists and impact of the French experts' conference

Objective: To analyse the management of difficult intubation (DI) by French anaesthetists and the impact of the French experts' conference (EC) on thi s topic. Study design: Prospective, comparative, before/after study by questionnaire carried out in Aquitaine, Provence-Alpes-Cote d'Azur and Alsace-Lorraine. Material and methods: A questionnaire on demographical data, detection of D I, management techniques and desiderata for continuing education on DI, was sent three months before the publication of the EC to 100 randomly selecte d anaesthetists, in each region (group PRE). Three months after the diffusi on of the EC, the questionnaire completed by a survey on the impact of the EC was sent to 100 other randomly selected anaesthetists in each region (gr oup POST). In the latter group, anaesthetists who considered the EC were co mpared to those who did not. Results: The participation rate was 91% for the group PRE and 79% for the g roup POST respectively. Both groups were not significantly different for ag e, gender, position and seniority. Most used techniques that included blind nasal intubation (84%), intubation through laryngeal mask (82%), and intub ation with fibrescope (53%). Demands for additional training were for trans laryngeal ventilation (68%), intubation with fibrescope (64%), retrograde i ntubation (52%), and intubation through a laryngeal mask (46%) The EC was k nown by 71% of anaesthetists. In this group,the EC improved the assessment rate of the three recommended predictive criteria for DI from 12 to 28% (P < 0.02), but neither the management policy, nor the desiderata for addition al training. Conclusion: Currently, the search of predictive indicators for Di is not sy stematically applied. The EC has only slightly modified the practice patter ns. The need for additional training is important. (C) 1999 Elsevier, Paris .