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

Abstract

Summary Background 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. Methods 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. Results 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%). Discussion 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.

Unreported deaths in pediatric surgery and anesthesia: a national, twenty year report

“…The importance of specific training in pediatric anesthesia is essential and an appropriate approach to difficult pediatric airways is crucial. (12,13) Our findings cannot be compared to other published studies, since this was the first time that an attempt was performed to estimate unexpected and unreported perioperative mortality through mass media report. We included all kinds of complications, both surgical and anesthesiological while other reviews and databases selectively report anesthesiological or surgical complications, (1,3,14,15) not allowing an understanding of the real overall mortality rate in the pediatric surgical setting.…”

Careful Planning in a Pediatric Expected Difficult Airway in a Specialized Tertiary Hospital: What can Go Wrong? A Case Report

“…Since the incidence of expected pediatric difficult airway is very low, even in specialized centers, and those ending in a surgical approach are even more uncommon, this topic is not extensively exposed [1,10,11]. We also agree that care must be taken not to overfill the trolley with extra 'specialized' equipment as not to limit the accessibility of emergency equipment [10,12]. However, we think that is important to highlight this topic because, as we reported, the detailed revision of all material and equipment can make the difference in the efficacy and celerity of our actions.…”

Description and function of a difficult airway service

“…Practice guidelines addressing the difficult airway in adults have improved the safety of clinical practice by reducing the need for an emergency surgical airway intervention . Consensus guidelines for the pediatric patient are similar in framework to the approach suggested for the difficult adult airway In contrast to adults, the unexpected difficult airway represents a smaller proportion of the difficult airway population as numerous congenital conditions often caution the pediatric specialist to suspect a difficult airway. The difficult airway in a child, like an adult, is defined as a patient who is difficult to provide effective bag‐mask ventilation and/or who is challenging to intubate.…”

“…The comprehensive plan for the service also required a number of capital purchases for airway equipment to assure the service could provide effective and timely consultation In addition, the identification and long‐term follow‐up for the child required additions and alerts added to the electronic medical record. The support of the surgical services committee, the medical director, and hospital and nursing leadership as well as changes to assure an effective method was in place to recognize and follow children who had a difficult airway (Figure ).…”

“…This approach assures an expert in airway management can assist in the care of a critically ill child. In the child who has a congenital or acquired airway abnormality, emergency airway management is often challenging and often requires additional help and specialized equipment . When a difficult airway is encountered in a child, the morbidity and mortality are reported to be greater than in adults .…”