Clarke M B, Forster P, Cook T M
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
Br J Anaesth. 2007 Sep;99(3):425-8. doi: 10.1093/bja/aem163. Epub 2007 Jun 27.
The emergence of variant Creutzfeldt-Jakob disease (vCJD) prompted guidelines from the Department of Health that stress the use of disposable and protective equipment. This survey explores current methods of airway management for tonsillectomy in the UK and ascertains anaesthetists' current knowledge and opinions of the guidelines and of vCJD.
Three hundred and five questionnaires were sent to all Royal College tutors across the UK to explore the current practice and adherence to the guidelines.
The tracheal tube was the most frequently used airway across all age groups: 87% for <3 yr old, 79% for 3-16 yr old, and 73% for adults. Of the respondents who intubated, 57% protected the laryngoscope blade with a disposable sheath or used a disposable blade, while others used a reusable laryngoscope blade without protection. Fourteen per cent protected the laryngoscope handle, as recommended. When a reusable classic or flexible laryngeal mask airway was used, 45% reused it after routine sterilization. Thirty-eight per cent of respondents were unaware that any recommendations existed, 55% disagreed with them, and 84% were not fully compliant with them. Compliance rates did not differ between the anaesthetists who agreed or disagreed with the recommendations. Overall full compliance was achieved by only 16% of respondents. The most common reason for non-compliance was the lack of protection of the laryngoscope handle.
The survey demonstrates widespread non-compliance with and lack of knowledge of, national guidelines.
变异型克雅氏病（vCJD）的出现促使卫生部出台了强调使用一次性和防护设备的指南。本调查探讨了英国扁桃体切除术当前的气道管理方法，并确定麻醉医生对该指南以及vCJD的现有认识和看法。
向英国所有皇家学院导师发送了305份问卷，以探究当前的实践情况以及对指南的遵守情况。
气管导管是所有年龄组中最常用的气道：3岁以下儿童中使用率为87%，3至16岁儿童中为79%，成人中为73%。在进行插管的受访者中，57%使用一次性护套保护喉镜镜片或使用一次性镜片，而其他人则使用未加保护的可重复使用喉镜镜片。按照建议，14%的人保护了喉镜手柄。当使用可重复使用的经典或柔性喉罩气道时，45%的人在常规消毒后再次使用。38%的受访者不知道有任何相关建议，55%的人不同意这些建议，84%的人未完全遵守这些建议。同意或不同意这些建议的麻醉医生之间的遵守率没有差异。总体而言，只有16%的受访者完全遵守了规定。不遵守规定的最常见原因是未对喉镜手柄进行保护。
该调查表明，对国家指南普遍存在不遵守和缺乏了解的情况。
