The Airway Lead: opportunities to improve institutional and personal preparedness for airway management

Major complications associated with airway management are rare but often have serious consequences. Complications frequently result from failures in communication and teamwork. We performed a systematic review on the effect of simulation-based team training on patient outcomes, healthcare professionals' clinical performance and preparedness for airway management. We included studies with simulation-based team training in airway management as the educational intervention, using any comparator, outcome and design. Two authors independently selected articles and assessed risk of bias using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education. We screened 1248 titles and evaluated 116 full-text articles. Twenty-two studies were included. The Kirkpatrick model for evaluation of training was used to organise outcomes. Four studies reported patient-centred outcomes (Kirkpatrick level 4), and three studies' outcomes related to healthcare professionals' clinical performance (Kirkpatrick level 3). The results were ambiguous and the studies had significant methodological limitations, making it difficult to draw conclusions on the effect of simulation-based team training. To describe preparedness for airway management, we used outcomes related to participants' attitudes or perceptions and outcomes related to knowledge or skills demonstrated in a test setting (Kirkpatrick level 2). Most studies reporting these outcomes were in favour of simulation-based team training, but were prone to bias. We consider the current evidence to be weak and recommend that future research should be based on randomised study designs and patient-centred outcomes.

The effect of disaster management training program on emergency nurses' knowledge, skills, and personal preparedness in Palestine.

BackgroundNumerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management.MethodsThis retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria.ResultsOf the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital.ConclusionsProper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.

Background: Difficult airway management remains a major concern in anesthesia, with unanticipated intubation failures increasing perioperative morbidity and mortality. Accurate preoperative identification of at-risk patients is essential for safe airway management and reducing complications like hypoxia and failed intubation. Among airway assessment tools, the Modified Mallampati Classification (MMP) and Acromio-Axillo-Suprasternal Notch Index (AASNI) are commonly used. This study compared the predictive accuracy of MMP and AASNI in forecasting difficult visualization of the larynx (DVL) during direct laryngoscopy. Methods: A prospective cohort study was conducted on 106 adult patients aged between 18 and 60 years, scheduled for elective surgeries requiring general anesthesia and endotracheal intubation. Each patient underwent preoperative airway assessments using MMP and AASNI. During laryngoscopy, the Cormack-Lehane (CL) grading was recorded. Diagnostic parameters—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio, and likelihood ratios—were calculated to evaluate the predictive performance of MMP and AASNI. Results: Of the 106 participants, 58 (54.7%) were male and 48 (45.3%) were female. The mean age was 38.11 ± 9.88 years, with the majority aged 40–50 years (38.7%). The average BMI was 24.75 ± 2.33 kg/m². AASNI showed higher sensitivity (83.3%) and NPV (93.9%) compared to MMP (41.67% and 83.7%, respectively), while MMP had greater specificity (87.8%). Both tools shared equal PPV (50%) and diagnostic accuracy (77.36%). AASNI demonstrated a higher odds ratio (15.5 vs. 5.14) and lower negative likelihood ratio (0.220 vs. 0.664), confirming superior predictive performance. Conclusion: AASNI is a more reliable and objective predictor of difficult laryngoscopy than MMP. It enhances preoperative airway assessment and supports better preparedness for airway management. Recommendations: Routine use of AASNI is recommended in pre-anesthetic evaluations. Future multicentric studies with larger, diverse populations are warranted to further validate its effectiveness and generalizability.

Wolf-Hirschhorn Syndrome (WHS), also known as Chromosome 4 deletion syndrome, is a rare hereditary disease with a prevalence of 1 in 50,000. It occurs due to the microdeletion of the short arm of chromosome 4, specifically the 4p16.3 domain. Patients with WHS exhibit diverse phenotypes, including growth retardation, developmental delay, congenital heart disease, and convulsions, depending on the amount of deleted genetic material. This case report focuses on a 25-year-old male who was admitted for cataract extraction and posterior chamber intraocular lens implantation. Through gene analysis, the patient was diagnosed with WHS. He exhibited micrognathia, a short neck, kyphoscoliosis, seizure disorder, and mental retardation. Additionally, he had severe kyphoscoliosis, which resulted in restrictive lung disease. These abnormalities posed significant challenges for anaesthetic management. To ensure a successful general anaesthesia, adequate preparedness for difficult airway management was crucial. A thorough cardiovascular and neuromuscular examination was conducted preoperatively to rule out associated anomalies and minimise complications. The patient’s perioperative antiepileptic cover was continued. Extubation proved challenging due to the patient’s mental retardation and restrictive lung disease. This case underscores the importance of effective anaesthetic management for patients with this rare condition undergoing cataract surgery under general anaesthesia.

Emergency cricothyrotomy is a rare but critical intervention required during a "cannot intubate, cannot oxygenate" airway emergencies; however, many anesthesia providers lack confidence in performing this high-acuity, low-frequency procedure. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the effectiveness of a structured, simulation-based educational intervention on self-efficacy and confidence among Student Registered Nurse Anesthetists. A pre-post intervention design was implemented in a high-fidelity academic simulation laboratory with 17 Student Registered Nurse Anesthetists. The intervention included a didactic presentation, instructional video, and hands-on simulation using anatomically realistic airway models. Self-efficacy was measured using surveys adapted from Bandura's self-efficacy framework, utilizing a continuous 0-100 numeric confidence scale across four procedural domains. Due to technical limitations and violations of normality assumptions, Mann-Whitney U tests were used to compare pre- and post-intervention groups. Statistically significant improvements were observed across all measured domains (p < 0.001). These findings support simulation-based education as an effective strategy to enhance provider confidence and preparedness for emergency surgical airway management.

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

Airway management equipment and practice: time to optimise institutional, team, and personal preparedness