Anticipation of the Difficult Airway: the Preoperative Airway Assessment Form

Anticipation of the Difficult Airway: the Preoperative Airway Assessment Form as an Educational and Quality Improvement Tool

The purpose of this study is to see if our experimental preoperative airway assessment form is a better indicator of difficult airway as compared to the anesthesia record that is presently used.

Study Overview

• Status: Completed
• Conditions: Endotracheal Intubation Risk Assessment
• Intervention / Treatment: Other: Preoperative assessment form

Detailed Description

Predicting difficult airway continues to be problematic for even the most seasoned of anesthesiologists. In our study, the resident class will be our sample population. The residents will be randomly assigned into two groups: the experimental group will be utilizing the new preoperative airway assessment form and the control group will be utilizing the standard anesthesia record. Simultaneously, a subset of our anesthesia experts will also be assessing patients preoperatively. The five areas of difficult airway management will be considered: difficult mask ventilation, difficult supraglottic airway, difficult laryngoscopy, difficult intubation, and difficult surgical airway.

According to the American Society of Anesthesiologists, the incidence of intubation has remained stable throughout the 1980s and 1990s despite attempts to predict its occurrence. Many of these cases were considered to be preventable; therefore, a better prediction of and preparation for difficult airway management may lead to a reduction in adverse events.

• Study Type: Interventional
• Enrollment (Actual): 89
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • Memorial Hermann Hospital, Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• CA-1, CA-2, and CA-3 anesthesiology residents starting from July 2008-July 2010

Exclusion Criteria:

• the same anesthesiology residents who are working with patients 17 and younger, patients who are already intubated, and patients undergoing emergent surgery.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Difficult Airway Assessment Form	Other: Preoperative assessment form; (based on the american society of anesthesiologists)components of the form include: neck measurements; neck mobility; mallampati; wilson's test; pre-existing conditions; and predictions of difficult mask ventilation, supraglottic airway, laryngoscopy, intubation, and surgical airway.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Use of an experimental preoperative assessment form by residents will result in more complete documentation of important airway features compared to use of the current forms	interim analysis will be assessed after 1 year

Secondary Outcome Measures

Outcome Measure	Time Frame
use of the experimental preoperative assessment form will result in greater resident recognition of patients at high risk for a difficult airway as judged independently by one of 3 senior faculty investigators.	interim analyses will be assessed after 1 year
the percentage of patients intubated using an awake method will be greater among residents using the new form than those using the current form	interim analysis will be assessed after 1 year
the percentage of patients requiring multiple intubation attempts or use of invasive airway techniques will be lower among residents using the new form.	interim analysis will be assessed after 1 year
spontaneous knowledge of important airway features will be more complete among residents using the new form at 18 months of training.	interim analysis will be assessed after 1 year
observations made during this study will allow refinement of the new form to augment the identification of patients with difficult airway.	interim analysis will be assessed after 1 year

Collaborators and Investigators

• Sponsor: The University of Texas Health Science Center, Houston
• Collaborators: Foundation for Anesthesia Education and Research
• Investigators: Principal Investigator: Carin A Hagberg, MD, University of Texas at Houston Health Science Center, Medical School

Publications and helpful links

Helpful Links

• university of texas at houston home page

Study record dates

Study Major Dates

• Study Start: August 1, 2008
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: December 21, 2009
• First Submitted That Met QC Criteria: December 21, 2009
• First Posted (Estimate): December 23, 2009

Study Record Updates

• Last Update Posted (Estimate): September 25, 2014
• Last Update Submitted That Met QC Criteria: September 23, 2014
• Last Verified: September 1, 2014

More Information

Terms related to this study

• Keywords: risk; intubation; assessment; endotracheal; difficult
• Other Study ID Numbers: 07-0144