Preferences of Canadian anesthesiologists in difficult intubation and cannot intubate--cannot ventilate situations

Abstract

Purpose: The purpose of this study was to determine Canadian anesthesiologists' preferences in difficult intubation and cannot intubate–cannot ventilate (CICV) situations. Methods: A web-based survey was emailed to Canadian Anesthesiologists' Society members asking about preference, experience, and comfort using airway equipment in (a) a difficult intubation situation in which direct laryngoscopy and bougie failed, and (b) a CICV situation. Results: 2532 invitations for the survey were sent; 997 responded. Demographics: male 69%, female 31%; resident 13%, staff anesthesiologist 87%; teaching hospital 71%, community hospital 29%. In a difficult intubation situation with failed direct laryngoscopy, first choice alternative technique was the videolaryngoscope (90%). Most respondents felt comfortable with the videolaryngoscope, fiberoptic bronchoscope, and intubating Laryngeal Mask Airway (ILMA) [Table]. 69% had encountered CICV in real life and the top three choices in a CICV situation were wireguided cricothyroidotomy (CT) (39%), IV catheter CT (28%), and tracheostomy (23%). Only about 10% have performed wire-guided CT, IV catheter CT, or tracheostomy on patients [Table 1]. Approximately 50% were comfortable with IV catheter CT or wireguided CT, while most were not comfortable with tracheostomy, open surgical CT, and scalpel bougie CT. Conclusion: Our survey showed that in a difficult intubation situation, the preferred alternative airway technique was videolaryngoscope whereas in a previous survey in 2005 [1], lighted stylet, bronchoscope, and ILMA were selected. In a CICV situation, wireguided CT was preferred over IV catheter CT whereas in a previous survey [1], the IV catheter CT was preferred by the majority.