The difficult airway trolley in pediatric anesthesia: an international survey of experience and training

Abstract

The pediatric difficult airway can be unexpected, leading to significant morbidity and mortality. Standardized emergency airway equipment should be available on a regularly checked difficult airway trolley (DAT). We conducted a survey to investigate pediatric anesthetists' knowledge, experience, and confidence with the DAT. Members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI), European Society for Paediatric Anaesthesiology (ESPA) and their national societies, Canadian Pediatric Anesthesia Society (CPAS), and Society for Paediatric Anaesthesia in New Zealand and Australia (SPANZA) were invited to complete a survey between January and April 2011. Six hundred and ninety-three anesthetists replied to the questionnaire. Six hundred and thirty-three (92%) stated they have a DAT in their theater suite, with 587 (98%) knowing its location. Three hundred and eight-seven (56%) anesthetists received formal DAT training. The lowest training levels were observed in Australia and the UK; 42% and 59%, respectively. Those receiving training were more likely to be confident/very confident in knowing the DAT contents (r = -0.321, P = 0.01). Three hundred and fifty-five (59%) anesthetists had used the DAT in the last 6 months, 82 (14%) in the last 6-12 months, 91 (15%) >1 year ago, and 72 (12%) had never used it. Frequency of use correlated moderately with higher confidence levels (r = -0.398, P = 0.01). One hundred and eight-three (31%) reported having experienced problems with DAT equipment (missing 20%, faulty 4%, unfamiliarity 7%). Training and recent use of the DAT increases anesthetists' confidence, but is not a universal practice. A significant number of anesthetists reported problems with the DAT, raising issues of equipment maintenance and quality control.