Awake fibreoptic intubation skills in obstetric patients: a survey of anaesthetists in the Oxford region

A survey of anaesthetists in the Oxford region was conducted to determine t heir skills and practice in performing awake fibreoptic intubation. Forty-t wo consultant obstetric anaesthetists (group O), 21 consultant anaesthetist s with an interest in difficult airway management (group D) and 20 anaesthe tic specialist registrars in their final training year (group S) were sent a questionnaire on management of a patient with a known difficult airway fo r elective caesarean section. All but one responded. If regional anaesthesi a was unsuccessful or contraindicated, 75/82 respondents (91.5%) would choo se to secure the airway by awake intubation. Of the remaining seven, six wo uld use general anaesthesia and spontaneous respiration, five (6.1%) with t he laryngeal mask airway and one (1.2%) with mask and airway and one (1.2%) local infiltration by the surgeon, Although awake fibreoptic intubation wa s the technique chosen by 98.7%, only six (8.1%) had experience of its perf ormance in an obstetric patient. Of the 68 anaesthetists without such exper ience, only 12/31 (38.7%) group O compared to 13/18 (72.2%) group D and 12/ 19 (63.2%) group S would be confident to perform awake fibreoptic intubatio n ill an obstetric patient. Only one anaesthetist in the survey practised a wake fibreoptic intubation in non-obstetric patients regularly (>3/month). However, 69/82 respondents replied that all consultant obstetric anaestheti sts should be experienced in performing awake fibreoptic intubation. We con clude that despite the value of awake fibreoptic intubation, consultant obs tetric anaesthetists are less confident in performing it than those with an interest in difficult airway management and final year specialist registra rs. (C) 2000 Harcourt Publishers Ltd.