Current airway management practice among Swiss anesthesiologists : Results of a national survey.

Abstract

Background: While limited data on the impact of implementing guidelines in airway management on outcomes exist, there is a consensus that the implementation and the adherence to guidelines enhance patient safety. Recently, the Swiss Society for Anesthesiology and Perioperative Medicine (SSAPM) endorsed the guidelines of The Fondation Latine des Voies Aériennes (FLAVA) as the official guidelines for airway management in Switzerland. This study aimed to determine current practice of airway management in Switzerland.

Objective: To determine the available equipment, the differences between institutions and between specialists and residents in dealing with airway management.

Methods: In collaboration with the SSAPM, a covering letter with a survey link to the questionnaire used in the online airway management survey among German anesthesiologists was sent to all heads of departments of anesthesia and members of the SSAPM in August 2023. The participants (residents and specialists) were asked about their personal and institutional backgrounds, access to airway management devices, awareness of recognized airway management guidelines and the importance and application of airway management techniques.

Results: Overall, 555 anesthesiologists participated in the survey (response rate 21%). The main findings were: in general, Swiss anesthesia departments are well-equipped and adhere to airway management guidelines. The guidelines of FLAVA are only known by just over 50%. The vast majority used the traditional screening tests to identify an airway that might be potentially difficult to manage. Of the respondents, 25% still adhere to the myth that a mask ventilation check is necessary before the administration of a muscle relaxant and 14% said that their institution used video laryngoscopy as the primary intubation device. More than 80% think that the expertise to perform awake fiberoptic intubation is important for their daily practice; however, 31% consider their expertise in this technique to be insufficient. In other words, there is a big safety gap.

Conclusion: Swiss anesthesia departments are well-equipped and adhere to airway management guidelines. The need for regular training to gain and maintain expertise in managing difficult airways, especially to future specialists, still prevails. Thus, developing and establishing a nationwide educational program in airway management and its continuous evaluation would be a milestone for patient safety.