Airway management in Greece: a nationwide postal survey

The aim of this study was to identify Greek anesthesiologists' difficult airway management practices, as well as the availability of equipment and familiarity with different airway management techniques.

A questionnaire containing 21 questions was posted to the vast majority of specialist anesthesiologists practicing in Greece (N.=849). Filled copies of the questionnaire were returned anonymously.

Response rate was 42% (360/849). Preoperative evaluation was performed by 95% of the respondents, with senior anesthesiologists relying mostly on subjective estimation of the airway. Ninety percent of the respondents had direct access to a difficult airway cart. Laryngeal masks were available in most anesthesia Departments (86%), but expertise was still unsatisfactory, especially in hospitals with a lower workload. Spreading and familiarity with newer airway adjuncts was insufficient, especially in smaller anesthesia Departments. Only 39% of the respondents had a flexible fibrescope readily available. Sixty percent could be considered skilled with laryngeal masks and 11% with fibrescopes. When the occasion for fibrescope use did occur, less senior anesthesiologists opted for laryngeal masks and were clearly less inclined towards surgical intervention. However, for the more senior anesthesiologists surveyed, the application of a face mask with a ''two hands'' technique and more traditional supraglottic airway devices were found to be more common.

There are shortfalls in various areas of airway management in Greece, in particular with the availability of modern airway devices and training in fibrescopic intubation.