Managing the unanticipated difficult airway in Africa: a survey of available devices and techniques
Ezihe-Ejiofor, J.A.
Managing the unanticipated difficult airway in Africa: a survey of available devices and techniques - 2015
NMUH Staff Publications EMBASE 70
<span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">In low resource settings the unanticipated difficult airway is often associated with a poor outcome [1]. Difficult intubation drills are the exception rather than the rule and difficult intubation trolleys do not exist in many hospitals. There is also a huge variation in the availability of aids to difficult intubation. This survey was conducted to identify equipment and strategies available to manage the unanticipated difficult airway in different regions in Africa. By capturing the spectrum of sophistication of airway equipment and training, the results of this survey would highlight need. Many UK-based anaesthetists now volunteer to work in low resource countries [2]. Goodwill needs guidance to achieve its goal. It was hoped that the results would add to existing guidance and enable resources to be channelled in a more structured and coordinated way. Methods We distributed a self-administered questionnaire to delegates attending the 5th All Africa Anaesthesia Congress in April 2013. We chose four countries representing the four corners of the continent: Egypt (North), Kenya (East), Nigeria (West) and South Africa. These four countries had national associations of anaesthetists. One delegate was asked to respond per institution. The questionnaire comprised three domains: demographics, availability of different aids to intubation and structure of airway training. Results We received responses from 35 hospitals. The majority of respondents in each regional cohort worked in tertiary hospitals. Airway training was conducted on patients and only 26% (9/35) of hospitals reported additionally using manikins for airway training. Standard laryngeal masks were available in 91% (32/35) of responding hospitals. Tracheal tube introducers were available in 74% (26/35) of hospitals. (figure present). Discussion Our survey results highlight existing equipment and skills around which sustainable difficult airway training can be delivered in low resource settings. A bougie is a simple, relatively inexpensive adjunct that can help secure the airway in simulated grade 3 difficult intubations [3]. It is desirable that any facility that delivers airway management during anaesthesia should have bougies as a minimum standard. Optimal bougie use is part of Plan A of the Difficult Airway Society intubation guidelines. Anecdotal reports suggest the bougie is often not used optimally. This is more so in low resource settings. Structured patient based and manikin supplemented training in optimal bougie use can be delivered even in low resource settings. This should facilitate safe management of the unanticipated difficult airway.</span> [Conference abstract]</span>
Managing the unanticipated difficult airway in Africa: a survey of available devices and techniques - 2015
NMUH Staff Publications EMBASE 70
<span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">In low resource settings the unanticipated difficult airway is often associated with a poor outcome [1]. Difficult intubation drills are the exception rather than the rule and difficult intubation trolleys do not exist in many hospitals. There is also a huge variation in the availability of aids to difficult intubation. This survey was conducted to identify equipment and strategies available to manage the unanticipated difficult airway in different regions in Africa. By capturing the spectrum of sophistication of airway equipment and training, the results of this survey would highlight need. Many UK-based anaesthetists now volunteer to work in low resource countries [2]. Goodwill needs guidance to achieve its goal. It was hoped that the results would add to existing guidance and enable resources to be channelled in a more structured and coordinated way. Methods We distributed a self-administered questionnaire to delegates attending the 5th All Africa Anaesthesia Congress in April 2013. We chose four countries representing the four corners of the continent: Egypt (North), Kenya (East), Nigeria (West) and South Africa. These four countries had national associations of anaesthetists. One delegate was asked to respond per institution. The questionnaire comprised three domains: demographics, availability of different aids to intubation and structure of airway training. Results We received responses from 35 hospitals. The majority of respondents in each regional cohort worked in tertiary hospitals. Airway training was conducted on patients and only 26% (9/35) of hospitals reported additionally using manikins for airway training. Standard laryngeal masks were available in 91% (32/35) of responding hospitals. Tracheal tube introducers were available in 74% (26/35) of hospitals. (figure present). Discussion Our survey results highlight existing equipment and skills around which sustainable difficult airway training can be delivered in low resource settings. A bougie is a simple, relatively inexpensive adjunct that can help secure the airway in simulated grade 3 difficult intubations [3]. It is desirable that any facility that delivers airway management during anaesthesia should have bougies as a minimum standard. Optimal bougie use is part of Plan A of the Difficult Airway Society intubation guidelines. Anecdotal reports suggest the bougie is often not used optimally. This is more so in low resource settings. Structured patient based and manikin supplemented training in optimal bougie use can be delivered even in low resource settings. This should facilitate safe management of the unanticipated difficult airway.</span> [Conference abstract]</span>