The Impact of Airway Technique on Anesthesia Control Time

Few studies have examined the impact of video laryngoscopy (VL) on operating room efficiency. We hypothesized that VL reduces anesthesia control time (ACT), a metric of anesthesia efficiency, compared with fiberoptic intubation (FOI) in potentially difficult airways, but that direct laryngoscopy (DL) remains more efficient in routine cases. We performed a multi-institutional, retrospective chart review of anesthetic cases from 2015 to 2016. Cases were compared based on choice of airway technique (laryngeal mask airway [LMA], DL, VL or FOI) and ACT. Generalized linear models with gamma distribution and log link were then used to model the data to control for variables including ASA physical status (PS), Mallampati (MP) score, body mass index, and presence of a trainee. ACT was analyzed for 32,542 cases. LMA insertion was associated with a median ACT of 10 min (CI 8-14 min), DL 14 min (CI 11-18 min), VL 17 min (CI 13-21 min) and FOI 20 min (CI 14.5-26 min). Modeling confirmed these results when controlling for variables expected to increase the ACT. However, modeling also revealed that presence of a trainee minimizes the increase in ACT for cases using VL or FOI. Use of VL in patients with a high MP score may improve anesthesia efficiency in the operating room. ASA PS, MP score, and presence of a trainee are all associated with an increased ACT. Trainee presence with both FOI and VL was associated with reduced increases in ACT for these devices.