A survey of anaesthetic practice in predicting difficult intubation in UK and Europe.

CONTEXT: Unexpected difficulty in tracheal intubation is an intermittent and often terrifying problem for all practising anaesthetists. There are many preoperative assessment tests to predict a difficult laryngeal view or a difficult intubation, but we found no published evidence of how frequently these predictive tests are used or how useful they are perceived to be by anaesthetists.

OBJECTIVE: We decided to ask UK and non-UK anaesthetists attending the Annual Scientific Meeting of the European Society of Anaesthesiology about their practice in predicting difficult intubation.

DESIGN: The study was conceived as a survey.

SETTING: The airway tests were compiled into a questionnaire, hand distributed among anaesthetists at Euroanaesthesia - the European group (after excluding UK attendees) - and posted to randomly selected anaesthetists in the UK - the UK group.

PARTICIPANTS: Overall, 888 of 1230 (72%) questionnaires were completed. The response rate from the UK group of anaesthetists was 69% (481 of 700) and from the European group was 77% (407 of 530).

RESULTS: On a scale 1 (never) to 5 (always), the mean score for frequency of use was similar for both groups of anaesthetists and ranged from about 4 for mouth opening to about 1 for Nodding Donkey. The mean score for usefulness (1 = useless, 5 = extremely useful) ranged from about 3.7 to 2 for the same two tests. The UK group found most tests slightly less useful than did the European group. With regard to the frequency of assessing the airway, 9% of the European group, but 16% of the UK group, failed always (score 5) or regularly (score 4) to assess the airway before general anaesthesia. Furthermore, 21 and 36% of the UK and European groups, respectively, failed to do so before regional anaesthesia.

CONCLUSION: These results are a cause for concern with regard to both airway management training and patient safety.