Equipment list for difficult airway management.

Abstract

Teaching airway skills should be central to anaesthesia training, as problems with respiratory and airway management may lead to significant morbidity and mortality [1]. We previously reported that a training module for difficult airway management is often not provided in Japan and the UK [2], and that both the level of tutors' expertise with the use of each airway device (or procedure) and the format of the syllabus for trainees varies considerably between the two countries. Not only are evidence-based guidelines for difficult airway management and the contents of a syllabus of basic and advanced airway management required, but equipment suitable for emergency airway management should readily be available [3]. We asked Japanese tutors whether an emergency kit for difficult airway management was immediately available. Sixty-seven of 89 Japanese tutors (75%) returned a completed questionnaire. Only 12 of the 67 tutors (18%) reported that there was emergency equipment immediately available in theatre to manage difficult airways. A previous study showed that a quarter of UK operating theatres did not have emergency equipment [4]. The Difficult Airway Society (DAS) and some others are formulating a minimum set of equipment recommended for difficult airway management [3]. However, there are some practical difficulties in doing so. For example, it may be impractical to recommend a useful device that is not widely used or available. There have been no reports on the availability of individual devices in operating theatres. We looked at the immediate availability in theatres in the UK of emergency equipment for difficult airway management (in July 2000), and had replies from 166 of 280 college tutors (60%). Availability of each device was as follows: gum elastic bougie (100%); classic laryngeal mask airway (100%); McCoy laryngoscope (96%); stylet (96%); fibreoptic bronchoscope (90%); percutaneous tracheostomy kit (68%); intubating laryngeal mask airway (49%); retrograde intubation kit (34%); Combitube (34%); lightwand (20%); and Bullard laryngoscope (6%). From these data, it might be reasonable to recommend, for example, that the McCoy laryngoscope, but not the Bullard laryngoscope, be available for all theatres. Of course, the current availability of each device is not the sole determinant for recommendation, and we should also take into consideration of the efficacy of each device in difficult airway management, the skills acquired by anaesthetists, and the practicality of inexperienced personnel acquiring the skills. In this era of evidence-based medicine, we believe that it is time to start collecting data and produce suggestions for a minimum set of equipment to be readily available to achieve safer airway management.