Anestezistler ve Diğer Hekimlerin Zor Hava Yolunu Öngörebilme Yetenekleri ve Zor Hava Yoluna Yaklaşımlarının Karşılaştırılması

Abstract

KILIÇ OLUKLU Y. Comparison of Anesthesiologists' and Non-Anesthesiologists Physicians' Ability to Predict Difficult Airway and Approaches to Difficult Airway. Hacettepe University Faculty of Medicine Department of Anesthesiology and Reanimation, Speciality Thesis. Ankara, 2021. It is necessary to maintain the patency of the airway and provide adequate ventilation in cases where spontaneous breathing cannot be maintained. In such a situation, it is vital for every physician to provide an airway, regardless of the specialty they work in. In this study, we basically aimed to investigate whether there is a difference between anesthetists and other physicians in their ability to predict difficult airway and to intervene correctly in cases requiring emergency airway management. The secondary output was to determine the parameters affecting this difference. After obtaining the approval of the ethics committee, the questionnaire forms were sent by e-mail to the doctors still working in Internal Medicine, Surgery, Intensive Care, Emergency Service, Family Health Center and Basic Sciences in various hospitals of Turkey between 1 July 2019 and 1 June 2020. The questionnaire included questions about airway management strategies, airway management devices, markers of difficult airway, approach to difficult airway, methods to facilitate intubation and prevent aspiration, use of end-tidal carbon dioxide, and difficult airway algorithms. It was observed that anesthetists were performing more airway management procedures than other physicians, as expected. Only 26% of other physicians were performing more than 35 airway management procedures per year. Airway management was generally performed in cases of CPR and respiratory distress. The airway management education of other physicians were found to be limited to the training in medical school. A total of 60.5% of non-anesthetist physicians did not know the definition of airway, most of them included only difficult intubation to the definition of difficult airway, and did not define difficult mask ventilation as part of difficult airway. As expected, anesthetists were found to be better able to recognize difficult airway markers and predict difficult airway compared to other physicians. Regardless of the specialty, the majority of physicians called for early help and made no more than three attempts. When faced with a difficult airway, the rate of use of LMA and videolaryngoscopy by non-anesthesiologists was found to be lower compared to anesthesiologists. Many of non-anesthesiologist physicians stated that they do not have basic airway management devices in their clinics, which are expected to be present according to the legal regulations of Ministry of Health. This situation was interpreted as the physicians' ignorance of these devices or their locations. It has been determined that non-anesthesiologists use methods that facilitate intubation and prevent aspiration and etCO2 monitoring less than anesthesiologists. The awareness of difficult airway algorithms was also less in non-anesthesiologists. The difficult airway management algorithm of Turkish Society of Anesthesiology and Reanimation was the most commonly used one. Airway management is an intervention that every physician should know well. Incorrect or insufficient application of basic airway skills can lead to life threatening consequences. Based on the results of our study; we concluded that both theoretical and practical training should be provided to physicians about airway management and difficult airway, physicians should be encouraged to use LMAs, videoryngoscopes and etCO2 more, and national difficult airway algorithms should be updated.