Formal instruction in difficult airway management. A survey of anesthesiology residency programs

Up to 30% of all deaths attributable to anesthesia are related to difficulties with airway management. The purpose of this study was to determine whether anesthesiology residents are receiving specialized instruction in the various techniques and mechanical devices currently recommended for airway management in patients with anticipated or unanticipated difficult airways.

A single anonymous questionnaire about resident instruction in the area of difficult airway management was mailed to the directors of 169 American anesthesiology programs.

Twenty-seven percent of the 143 programs from which there were responses require residents to participate in a rotation dedicated to management of the difficult airway. As they currently exist, rotations tend to be of short duration. Many are limited to lectures only and infrequently employ state-of-the-art teaching systems. In some programs, recognized airway management techniques such as the Bullard laryngoscope and esophageal-tracheal combitube are not taught at all.

Based on the data obtained by the authors, formal instruction in difficult airway management is not offered by most residency programs. It is commonly taught as difficult clinical situations arise. Because these difficulties occur sporadically, opportunities for teaching are occasional. Learning based on sporadic and occasional occurrences risks incomplete and nonuniform training of residents.