HOW CONTROVERSIAL ARE ANESTHETIC CONTROVERSIES

Study Objectives: To determine how controversial the management of a n umber of clinical scenarios that are labeled as controversial (eg, how to induce anesthesia in the ''open eye-full stomach'' patient) are am ong those practicing anesthesia. Design: Written survey. Setting: A na tional anesthesiology review course. Subjects: 575 anesthesiologists a ttending the review course. Interventions: Anesthesiologists were pres ented 11 scenarios regarding some specific controversies in anesthetic management; each scenario also described a suggested course of manage ment. Two questions were asked for each scenario: ''Is this acceptable practice?'' and ''Would you do this in your own practice?'' The scena rios included using succinyl-choline for an ''open eye-full stomach'' patient, not evaluating preoperatively, the cardiac status of a patien t after receiving adriamycin therapy, using triggering drugs after a n egative muscle biopsy for malignant hyperthermia, ordering a pregnancy test preoperatively for all females of child-bearing age, and seven o thers. Measurements and Main Results: For each scenario, comparisons b etween the number of respondents who felt a particular management was acceptable practice and the number who would do this in their own prac tice were made using chi-square analysis; p less than or equal to 0.05 was considered significant. 160 (27.8%) surveys were returned. In ten scenarios, there was 70% or less agreement about whether a technique was acceptable. In six scenarios, there was a significant difference b etween the number of-respondents who felt a suggested management was a cceptable practice and the number who would use it in their own practi ce. Conclusions: This survey of anesthesiologists regarding these cont roversial clinical scenarios showed that (a) most scenarios were in fa ct controversial amongst those in practice, and (b) there were dispari ties between whether a technique is believed to be acceptable practice and whether it would be used in one's own practice. (C) 1997 by Elsev ier Science Inc.