Extubation Technique Research Articles

Risk of postoperative pneumonia after extubation with the positive pressure versus normal pressure technique: a single-center retrospective observational study.

A normal pressure extubation technique (no lung inflation before extubation), proposed by the Japanese Society of Anesthesiologists to prevent droplet infection during the coronavirus disease 2019 (COVID-19) pandemic, could theoretically increase postoperative pneumonia incidence compared with a positive pressure extubation technique (lung inflation before extubation). However, the normal pressure extubation technique has not been adequately evaluated. This study compared postoperative pneumonia incidence between positive and normal pressure extubation techniques using a dataset from the University of Tsukuba Hospital. In our hospital, the extubation methods changed from positive to normal pressure extubation techniques on March 3, 2020 due to the COVID-19 pandemic. Thus, we compared the risk of postoperative pneumonia between the positive (April 1, 2017 to December 31, 2019) and normal pressure extubation techniques (March 3, 2020 to March 31, 2022) using propensity score analyses. Postoperative pneumonia was defined using the International Classification of Diseases, 10th Edition (ICD-10) codes (J13-J18), and we reviewed the medical records of patients flagged with these ICD-10 codes (preoperative pneumonia and ICD-10 codes for prophylactic antibiotic prescriptions for pneumonia). We identified 20,011 surgeries, including 11,920 in the positive pressure extubation group (mean age 48.2years, standard deviation [SD] 25.2years) and 8,091 in the normal pressure extubation group (mean age 47.8years, SD 25.8years). The postoperative pneumonia incidences were 0.19% (23/11,920) and 0.17% (14/8,091) in the positive and normal pressure extubation groups, respectively. The propensity score analysis using inverse probability weighting revealed no significant difference in postoperative pneumonia incidence between the two groups (adjusted odds ratio 0.98, 95% confidence interval 0.50 to 1.91, P = 0.94). These results indicated no increased risk of postoperative pneumonia associated with the normal pressure extubation technique compared with the positive pressure extubation technique. Clinical trial number: UMIN000048589 https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055364.

Perbedaan Tingkat Nyeri Tenggorokan Pasca Ekstubasi Endotracheal Tube (ETT) dan Laryngeal Mask Airway (LMA) di RSUD Dr. Soedirman Kebumen

General anesthesia is a condition in which the patient loses consciousness completely after taking certain medications. Sore throat is a common complication in postoperative patients with general anesthesia after extubation with laryngeal mask airway or endotracheal tube. The aim of this study was to compare the level of throat pain after extubation using an endotracheal tube versus a laryngeal mask airway. Methods: A quantitative cross-sectional approach was utilized, with accidental sampling as the technique. The study sample comprised 78 respondents who underwent surgery and were extubated with either an endotracheal tube or a laryngeal mask airway at Dr. Soedirman Hospital, Kebumen. Data analysis was conducted using the Mann-Whitney test. Results: Each group, consisting of endotracheal tube and laryngeal mask airway users, had 39 respondents. Throat pain was reported by 34 respondents (84.6%) in the endotracheal tube group and 27 respondents (69.2%) in the laryngeal mask airway group. The Mann-Whitney test yielded a p-value of 0.022, which is less than 0.05. Conclusion: There is a significant difference in the level of sore throat in postoperative patients with the laryngeal extubation technique with the laryngeal mask air way extubation technique and the endotracheal tube extubation technique at dr. Soedirman Kebumen Hospital.

Gambaran Kejadian Laringospasme Pada Tindakan Ekstubasi Pasca General Anestesi Di RSU Proklamasi Rengasdengklok

Background: Complications that can occur during extubation include laryngospasm. Laryngospasm is an exaggerated response stimulated by the presence of blood, secretions, or surgical debris, especially when the depth of anesthesia is light. If laryngospasm is not treated properly, there is a risk of causing morbidity and mortality. Objective: To describe the incidence of laryngospasm in extubation after general anesthesia at the Proklamasi Rengasdengklok General Hospital. Method: The design in this study is descriptive quantitative, the number of samples as many as 30 respondents were taken by accidental sampling. Data collection tools used observation sheets, the data were analyzed descriptively to determine the frequency and percentage of the type of extubation and the degree of laryngospasm. Result: The most frequently used extubation technique is the deep extubation technique, which is 21 people (70%). While conscious extubation as many as 9 people (30%). While the highest degree of laryngospasm was laryngospasm degree 0 as many as 22 people (73.3%), Grade 1 as many as 6 people (20%) and degree 2 as many as 2 people (6.7%) and none of the respondents experienced grade 3 laryngospasm. Conclusion: Most of the patients at RSU Proklamasi Rengasdengklok were extubated using deep extubation technique, and the majority of patients had grade 0 laryngospasm.

Extubation techniques in anaesthesia—a narrative review

Extubation techniques in anaesthesia—a narrative review

Case series of tracheal extubation in prone position after endoscopic retrograde cholangiopancreatography general anesthesia.

The study aims to present a 15-patient case series of tracheal extubation in the prone position after endoscopic retrograde cholangiopancreatography (ERCP) general anesthesia. Fifteen inpatients who underwent elective ERCP in our hospital were prospectively enrolled, and a series of case studies were conducted with the prone extubation technique after general anesthesia. All patients underwent routine operation of tracheal intubation under general anesthesia. After the surgery, when the train-of-four ratio (TOFr) ≥0.9, bispectral index (BIS) ≥80, tidal volume ≥6 ml/kg and the required actions could be performed, the endotracheal catheter was removed after sufficient negative pressure suction of oral secretions. After the endotracheal catheter was removed, the patient autonomously turned to the transport bed with the assistance of medical staff and was then admitted to the post-anesthesia care unit (PACU) for further observation. When the patient awoke, he had regained orientation, and presented stable vital signs, no nausea and vomiting, and no other discomfort symptoms, he/she was able to leave PACU and returned to the ward with a Steward score of ≥5. All 15 patients who underwent ERCP elective surgery were successfully extubated in the prone position after surgery. Transient hypoxemia with SpO2 below 90% occurred in 2 of the 15 patients and returned to normal with oxygen mask administration. 7 patients had coughs and were without special treatment. Another 1 patient showed transient abnormal hemodynamic fluctuations after extubation, mean airway pressure (MAP) was higher than 20% of the baseline value, and hemodynamics was stable after drug treatment. The prone extubation technique is feasible for ERCP general anesthesia patients. However, a larger sample size is needed to validate its safety and to verify whether there exist advantages of the extubation technique in a prone position over a supine position.

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review.

Several studies have investigated postextubation complications of the positive-pressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation. This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool. Six RCTs and 1 non-randomized controlled study were included in this systematic review (N = 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and re-intubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias. The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.

Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro.

Accumulated secretion above the endotracheal tube cuff can be aspirated during extubation after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H2O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H2O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended.

Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial.

Two orotracheal extubation techniques are described in the literature: the traditional technique and the positive-pressure technique. Although prior studies reported better clinical outcomes with the positive-pressure extubation technique, its superiority has not been extensively studied yet. This study was to determine whether the positive-pressure orotracheal extubation technique, compared with the traditional orotracheal extubation technique, reduces the incidence of major postextubation complications (up to 60 min) in critically ill adult subjects. This was a multi-center randomized clinical trial. Subjects age > 18 y, requiring invasive mechanical ventilation through an endotracheal tube, who met the orotracheal extubation criteria were included and randomized to traditional extubation group (removing the endotracheal tube by applying continuous endotracheal suctioning during the entire procedure) or positive-pressure group (application of pressure support mode at 15/10 cm H2O during cuff deflation and extubation). The primary measure was postextubation major complications, defined as the clinical evidence of at least one of the following: desaturation, upper-airway obstruction, or vomiting. A total of 725 subjects was randomly assigned to the traditional extubation group (n = 358) and positive-pressure group (n = 367). Seventeen subjects were eliminated and not included in the per-protocol analysis. Of 708 subjects, 185 (26.1%) developed at least one major complication. The incidence was 27.8% (96/345) in the traditional group compared with 24.5% (89/363) in the positive-pressure group. No statistically significant differences were observed between the 2 groups (absolute risk 3% [95 CI -3 to 10]; relative risk, 0.88 [95 CI 0.69-1.13], P = .32). Despite the trend toward the positive-pressure group, no statistically significant differences were observed. Our findings agree with the literature in that positive-pressure extubation is a safe procedure; therefore, both techniques may be used during extubation in critically ill adult patients.

Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial.

Background Respiratory distress syndrome (RDS) is a common cause of hospitalization and death in preterm infants who require surfactant treatment and respiratory support.Purpose This study aimed to compare the clinical outcomes of minimally invasive surfactant therapy (MIST) and the INtubation, SURfactant administration, and Extubation (INSURE) technique in preterm infants with RDS.Methods In this clinical trial, 112 preterm infants born at 28–36 weeks of gestation and diagnosed with RDS randomly received 200-mg/kg surfactant by MIST or the INSURE method. In the MIST group, surfactant was administered using a thin catheter (5F feeding tube); in the INSURE group, surfactant was administered after intubation using a feeding tube and the tracheal tube was removed after positive pressure ventilation was started. Nasal continuous positive airway pressure was applied in both groups for respiratory support and the postprocedure clinical outcomes were compared.Results The mean hospitalization time was shorter for infants in the MIST group than for those in the INSURE group (9.19± 1.72 days vs. 10.21±2.15 days, P=0.006). Patent ductus arteriosus was less frequent in the MIST group (14.3% vs. 30.4%, P=0.041). Desaturation during surfactant administration occurred less commonly in the MIST group (19.6% vs. 39.3%, P=0.023). There were no significant intergroup differences in other early or late complications.Conclusion These results suggest that surfactant administration using MIST could be a good replacement for INSURE in preterm infants with RDS since its use reduced the hospitalization time and the number of side effects.

Minimal invasive surfactant therapy in preterm infants with respiratory distress syndrome: a single-center experience.

Minimal invasive surfactant therapy (MIST) includes the tracheal instillation of surfactant via a thin catheter for the treatment of preterm infants with respiratory distress syndrome (RDS). We aimed to evaluate the impact of MIST compared to intubation, surfactant, extubation (INSURE) technique on respiratory outcomes. A prospectively recruited cohort of preterm infants ≤32 weeks with RDS was compared against a historical cohort of infants treated with INSURE. The primary outcome was the need for mechanical ventilation within 72 hours of age and secondary outcomes the overall need and duration of mechanical ventilation, the development of bronchopulmonary dysplasia, common morbidities, and survival. Thirty-six infants treated with MIST of 29.1±2.2 weeks' gestation and 1219±238 g birthweight compared against 37 infants of 28.8±2.3 weeks' gestation and 1195±336 g birthweight treated with INSURE. A lower proportion of infants treated with MIST required mechanical ventilation within 72 hours of age compared to those treated with INSURE (11% compared 32%, P=0.042). However, no significant differences were noted regarding the overall intubation incidence, bronchopulmonary dysplasia, other morbidities, or survival. In spontaneously breathing infants ≤32 weeks with RDS, the MIST technique was associated with a lower need for intubation within 72 hours of age, but otherwise with no significant differences regarding BPD or other neonatal morbidities.

Smooth Extubation and Smooth Emergence Techniques: A Narrative Review.

There is a paucity of literature on extubation technique and a lack of consensus regarding the definition of smooth extubation. This narrative review paper defines an ideal extubation, otherwise known as a “smooth extubation,” reviews perioperative criteria for extubation and risks and adverse events related to extubation, and explores various perioperative techniques that can be used to achieve a smooth extubation while caring for an uncomplicated patient without significant risk factors for extubation failure. In light of the evolving practice during the SARS CoV2 (COVID-19) pandemic to minimize aerosol generation and infection transmission, smooth extubation is particularly important.

Less invasive surfactant administration is associated with a higher need for nonpharmacological pain-relieving interventions compared to the intubation-surfactant extubation technique in preterm infants.

AimLISA is a promising method in improving preterm outcome. The aim of this study was to assess whether the INSURE (intubation‐surfactant extubation) technique or LISA (less invasive surfactant administration) procedure for surfactant administration is associated with more pain‐relieving interventions after the intervention in preterm infants.MethodsPreterm infants born at <32 weeks gestational age admitted to the Neonatal Intensive Care Unit of Innsbruck University hospital between Jan 2012 and June 2017 subjected to INSURE or LISA were included in the study, which was performed as a retrospective analysis of routinely collected data. Pain assessments were made bedside using the Bernese Pain Scale for Neonates.ResultsDuring the study period 15 preterm infants (median gestational age 30.7 weeks; range: 25.9‐32.0 weeks) were subjected to INSURE technique and 59 (median gestational age 29.4 weeks; range: 25.1‐31.4 weeks) to LISA. Infants subjected to LISA showed a higher need for nonpharmacological pain‐relieving interventions in the first three days of life.ConclusionLISA procedure compared to INSURE technique was associated with a higher need for pain‐relieving interventions in the first three days of life. Prospective randomized controlled trials are needed to optimize this less invasive method for surfactant application with special focus on pain in neonates.

Extubation and the Risks of Coughing and Laryngospasm in the Era of Coronavirus Disease-19 (COVID-19).

The coronavirus disease-19 (COVID-19) pandemic has prompted new interest among anesthesiologists and intensivists in controlling coughing and expectoration of potentially infectious aerosolized secretions during intubation and extubation. However, the fear of provoking laryngospasm may cause avoidance of deep or sedated extubation techniques which could reduce coughing and infection risk. This fear may be alleviated with clear understanding of the mechanisms and effective management of post-extubation airway obstruction including laryngospasm. We review the dynamic function of the larynx from the vantage point of head-and-neck surgery, highlighting two key concepts:1. The larynx is a complex organ that may occlude reflexively at levels other than the true vocal folds;2. The widely held belief that positive-pressure ventilation by mask can “break” laryngospasm is not supported by the otorhinolaryngology literature.We review the differential diagnosis of acute airway obstruction after extubation, discuss techniques for achieving smooth extubation with avoidance of coughing and expectoration of secretions, and recommend, on the basis of this review, a clinical pathway for optimal management of upper airway obstruction including laryngospasm to avoid adverse outcomes.

Nebulized Poractant Alfa Reduces the Risk of Respiratory Failure at 72 Hours in Spontaneously Breathing Surfactant-Deficient Newborn Piglets.

We have setup for the first time a long-term (72 hr) respiratory distress syndrome model in spontaneously breathing surfactant-deficient newborn piglets to investigate the continuous positive airway pressure failure rate with nebulized poractant alfa compared with that with the intubation surfactant extubation technique or continuous positive airway pressure only. Prospective randomized animal study. Biocruces-Bizkaia Health Research Institute Animal Facility. Eighteen newborn piglets (n = 6/group) with surfactant-deficient respiratory distress syndrome were randomized to three continuous positive airway pressure-ventilated groups: 1) nebulized surfactant (poractant alfa 400 mg/kg) via a customized investigational eFlow-Neos vibrating membrane nebulizer system, 2) bolus administration using the Intubation Surfactant Extubation method (200 mg/kg), or 3) continuous positive airway pressure alone. Pulmonary and hemodynamic variables were assessed at 6-hour intervals for 72 hours. Lung and brain histological analyses were performed. After bronchoalveolar lavages, piglets developed respiratory distress syndrome. Over the follow-up, both surfactant-treated groups had significantly better pulmonary outcomes than the continuous positive airway pressure alone group. Furthermore, unlike in the continuous positive airway pressure group, there were no cases of respiratory failure in either of the surfactant-treated groups. In newborn piglets with respiratory distress syndrome, the nebulization of 400 mg/kg of poractant alfa using a customized investigational eFlow-Neos nebulizer was found to be safe and effective in reducing the risk of respiratory failure in the 72 hours after treatment.

Endoscopy mask for safe extubation in patients with COVID-19.

Dear Editor, The risk of spreading coronavirus disease 2019 (COVID-19) virus through aerosol generating procedures (AGPs) is well documented.[1] Intubation and extubation are high AGPs, which are of major concern for an anesthesiologist and intensivists due to proximity to the patient. Recently various recommendations for anesthetic management of COVID-19 patients has been published.[12] These recommendations mainly focus towards safe tracheal intubation with less emphasis on safe extubation techniques. We believe that adequate dose muscle relaxants during laryngoscopy and intubation prevents coughing thus limiting aerosol generation. In contrast, the aerosol generation is much more during extubation than that of intubation due to the high incidence of coughing and bucking. Strategies like avoiding extubation inside the OR or extubation in a negative pressure room may prevent contamination but are not always feasible. Use of portable barrier hood devices[3] mask over the endotracheal tube (ETT) technique[4] and passing the ETT through the port, of a standard face mask,[5] have been described to minimize exposure during extubation, however, these techniques have limitations and are not full-proof. Hence, we describe a technique of extubation using endoscope mask (VBM Medizintechnik GmbH, Germany) [Figure 1], which further minimizes aerosol exposure despite proximity to the patient.Figure 1: Endoscopy mask with the silicon membrane and a small self-sealing hole with a cap (yellow arrow)Extubation Technique All providers managing extubation in COVID-19 patients should wear full personal protective equipment (PPE). Assessment for the readiness of extubation is crucial as rescue strategies are associated with increased risk of exposure. Before extubation, an adequate size endoscopy mask is placed over the patient's face by inserting the ETT through the membrane port of the endoscopy mask, after clamping the ETT at the angle of mouth [Figure 2a and b]. The membrane port of the endoscopy mask has a silicon membrane and a small self-sealing hole with a cap [Figure 1], which ensures a proper seal around the ETT. A viral filter is attached to the airway port of the endoscopy mask [Figure 2c]. At the time of extubation, a proper seal with the endoscopy mask is ensured before the deflation of the ETT cuff [Figure 2d]. The ETT is removed through the hole in the silicon membrane of the endoscopy mask. The hole in the silicon membrane is capped by the assistant and the close circuit is detached from the ETT distal to viral filter [Figure 2e]. The circuit is reattached to the viral filter, which is attached to the airway port of the endoscopy mask [Figure 2f].Figure 2: Extubation with endoscopy mask. (a) ETT clamped at the angle of mouth, (b) The ETT is passed through the small hole of the silicon membrane of endoscopy mask, after detaching the connector, (c) Clamp removed, circuit reattached to the ETT and a viral filter is attached to the airway port of the endoscopy mask (white arrow), (d) Cuff of the ETT deflated while maintaining a proper seal with the mask, (e) ETT removed and the hole in the silicon membrane is closed by its cap by the assistant, (f) The circuit is reattached to the filter attached with airway port of the mask (white arrow)Advantages of using endoscopy mask during extubation in COVID-19 patients are: the small self-sealing hole in the silicon membrane of the mask ensures adequate seal around the ETT and the flexible corrugated airway port of the mask can be diverted away from the person standing at the head-end, during extubation. We found this technique simple and effective and did not find any difficulty in testing this technique in a mannequin and non-COVID patients. The only limitation of this technique is that an additional viral filter is required to ensure adequate protection. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Surfactant therapy in premature babies: SurE or InSurE.

Preterm infants with respiratory distress syndrome (RDS) requiring surfactant therapy have been traditionally receiving surfactant by intubation surfactant and extubation technique (InSurE), which comprises of tracheal intubation, surfactant administration, and extubation. However, more recently noninvasive methods like least invasive surfactant therapy or minimally invasive surfactant therapy have been reported to be successful. These methods, avoid intubation thus minimize airway trauma and avoid barotrauma. The primary aim of this randomized trial was to compare the need for mechanical ventilation (MV) between the administration of surfactant via a thin catheter during spontaneous breathing and the InSurE technique. Preterm infant's ≤34 weeks with RDS requiring continuous positive airway pressure (CPAP) within 6 hours of life were prospectively randomized to receive early surfactant either by SurE (surfactant without endotracheal tube intubation) or InSurE technique. The need for MV within the first 72 hours and other related outcomes were analyzed between the two groups. One hundred seventy-five infants in each group were analyzed. The need for MV in the first 72 hours of life was significantly lower in the SurE group compared to the InSurE group (19% vs 40%, P < .01). Similarly, duration of oxygen therapy and hospital stay were significantly shorter in the SurE group. Furthermore, bronchopulmonary dysplasia (BPD) rate was significantly lower among the infants administered surfactant by the SurE technique. In preterm neonates with RDS who are stabilized on CPAP, the SurE technique for surfactant delivery results in the reduced need for MV and also may decrease the rate of BPD in some vulnerable subpopulations.

The Effects of Dexmedetomidine on Airway-Related Complications During Emergence from General Anesthesia in Nasal and Paranasal Surgeries

Background: Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed by special technique or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine has sedative and analgesic effects, without affecting respiratory status. Objectives: To evaluate the effects of dexmedetomidine on airway-related complications during emergence from general anesthesia (GA) in nasal and paranasal surgeries. Patients and Methods: This prospective randomized clinical study was included 90 patients of both sexes, admitted for elective nasal and paranasal sinus surgery. They were randomly allocated into three groups 30 patients each, Group A: Standard awake extubation technique. Group B: fully awake “no stimulation extubation” technique. Group C: Dexmedetomidine–group, who received intravenous (I.V) dexmedetomidine 0.5-1 μg/kg bolus in 100 ml of normal saline over 10 minutes before the end of surgery by 10 minutes, The dexmedetomidine bolus was followed by 0.2 μg/kg/hr which was stopped immediately when extubation was done. Results: The following parameters were assessed between the three groups: hemodynamics, airway-related complications, extubation time. Group C: was associated with a significant increase in extubation quality compared with group A and group B regarding hemodynamics, airway-related complications, extubation time. Conclusion: This study showed that the dexmedetomidine group associated with minimal circulatory reflexes and airway-related complications further to the advantage of short extubation time compared with the “no stimulation” extubation technique.

Comparison of Two Extubation Techniques in Critically Ill Adult Patients

Comparison of Two Extubation Techniques in Critically Ill Adult Patients

Advanced airway training in the UK: A national survey of senior anesthetic trainees.

Background and Aims:High-quality training in advanced airway skills is imperative to ensure safe anesthetic care and develop future airway specialists. Modern airway management skills are continually evolving in response to advancing technology and developing research. Therefore, it is of concern that training provisions and trainee competencies remain current and effective.Material and Methods:A survey questionnaire based on the airway competencies described in the Royal College of Anaesthetists’ curriculum and Difficult Airway Society guidelines was posted to all United Kingdom (UK) National Health Service hospitals to be completed by the most senior anesthetic trainee (ST 5–7, resident).Results:A total of 149 responses were analyzed from 237 hospitals with eligible anesthetic trainees (response rate 63%), including 53 (36%) and 39 (26%) respondents who had completed higher and advanced level airway training respectively. Although clinical experience with videolaryngoscopy was satisfactory, poor confidence and familiarity was identified with awake fiberoptic intubation, high frequency jet ventilation, at risk extubation techniques, and airway ultrasound assessment. Only 26 (17%) respondents had access to an airway skills room or had regular airway emergency training with multidisciplinary theater team participation. Reported barriers to training included lack of training lists, dedicated teaching time, experienced trainers, and availability of equipment.Conclusions:This national survey identified numerous deficiencies in airway competencies and training amongst senior anesthetic trainees (residents) in the UK. Restructuring of the airway training program and improvements in access to training facilities are essential to ensure effective airway training and the capability to produce future airway specialists.

Comparison of extubation techniques in patients undergoing bariatric surgery

Comparison of extubation techniques in patients undergoing bariatric surgery