Anticipation of the Difficult Airway: the Preoperative Airway Assessment Form

• 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 [ Time Frame: interim analysis will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  

• 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. [ Time Frame: interim analyses will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  
• the percentage of patients intubated using an awake method will be greater among residents using the new form than those using the current form [ Time Frame: interim analysis will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  
• the percentage of patients requiring multiple intubation attempts or use of invasive airway techniques will be lower among residents using the new form. [ Time Frame: interim analysis will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  
• spontaneous knowledge of important airway features will be more complete among residents using the new form at 18 months of training. [ Time Frame: interim analysis will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  
• observations made during this study will allow refinement of the new form to augment the identification of patients with difficult airway. [ Time Frame: interim analysis will be assessed after 1 year ] [ Designated as safety issue: Yes ]
  

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.