Difficult airway management and the novice physician.

BACKGROUND

Selection of the ideal airway device in patients with difficult airways (DA) or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP) who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5) patients who may be more difficult to intubate than normal weight patients.

MATERIALS AND METHODS

In this prospective randomized experimental study the author investigates a novice physician's use of the Bullard, Fiberoptic, Fastrach and Trachlight comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device.

RESULTS

The Fastrach was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic. A success rate of 20% (one of five) was achieved with the Trachlight on first attempt after 95 seconds. The Bullard was successful in 40 % (two of five) of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively.

CONCLUSIONS

In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach demonstrated the highest success rate.