Airway management is an important aspect in the practice of anaesthesia. There are many surveys conducted across the world^1-6 assessing difficult airway management, training and equipment availability. While, India has not published its own data and has no algorithms for management of difficult airway, we have adopted American society of anaesthesiologists (ASA) and Difficult Airway Society (DAS) algorithms for the training and management of airways. We plan to evaluate the current practice patterns of the Indian anaesthesiologists with special interest in Airway management, in management of predicted difficult airway and the available airway equipments as advised by the ASA. We survey anaesthesiologists who are members of Indian society of Anaesthesiologist (ISA) and All India difficult airway association (AIDiAA). 

MATERIALS & METHODS:

The Delphi survey methodology will be used. A panel of 5 senior physicians who are practicing anaesthesiologists will be involved directly in formulating the questionnaire. The first step in designing the survey will be to prepare a questionnaire with clinical relevance to the aims of the survey. We will be preparing a set of four case scenarios (2 emergency and 2 elective) keeping in mind the difficult airway possibilities at Supraglottic, periglottic and subglottic region, as well as a cervical spine injury along with elective case scenario. Re-evaluation of the questions will be made for the second time and answer options will be evaluated for their relevance to the aim of the survey. Multiple choice options will be created with an easy to use “check the box” system to provide responses. As the clinical practices will be expected to be different for different group of patients, multiple options of standard difficult airway management will be provided.

The set of questions will be formatted into two sections, i.e. the first section will consist of questions on personal details (i.e. demographic information including work practice (location and full-time equivalent percentage), age, duration of practice, anaesthesia qualifications, etc.) of the participants. The second part will cover availability of difficult airway equipment and will be based on the ASA’s suggested contents of a portable storage unit for difficult airway management. The third part consists of four case scenarios describing patients requiring tracheal intubation, as will be outlined in the Appendix. In all cases the airway will be predicted to be difficult. There will be 2 emergencies and 2 elective case scenarios. Of the emergency cases, there will be one case of suspected Supraglottic pathology, one involved periglottic pathology, subglottic and a trauma patient with unknown cervical spine status. Practitioners will be asked to select a method of induction, method of intubation and preferred adjunct device for each scenario.

STUDY PROCEDURE:

Conduct of survey

The database of the registered members of All India Difficult Airway Association (AIDiAA) whose members are distributed across the country, will be obtained after due permission. Also, delegates and faculties attending the National Airway conference to be held during 28^th Nov – 30^th Nov 2014 will be surveyed. The time period allotted to complete the survey will be 2 months. 3 reminders to complete the survey will be sent through e-mail to the non-responders during the study period.

Received data will be entered into an Excelâ„¢ (Microsoft Office 2003) spreadsheet by two independent operators and cross-checked. Partially incomplete forms will be included with blank responses coded as missing data. If two options are selected, then data will coded as missing.

STATISTICAL ANALYSIS:

Data will be analysed using SPSS version 14.0 (SPSS Inc., Chicago, IL, USA). Frequencies and cross-tabulations will be used to describe the data. Descriptive statistics will be used to present demographic data and to present the results of workplace scenarios and available equipment.

REFERENCES:

1.    Ortega R, Mehio AK, Woo A, Hafez DH: Videos in clinical medicine: Positive-pressure ventilation with a face mask and a bag-valve device. N Engl J Med 2007; 357:e4

2.    Adnet F: Difficult mask ventilation: An underestimated aspect of the problem of the difficult airway? Anesthesiology 2000; 92:1217-1218.

3.    Soleimanpour H, Gholipouri C, Golzari SE, Rahmani F, Sabahi M. Capnography in the emergency department. Emerg Med. 2012; 2:e123.

4.    Sokouti M, Montazeri V. Acute nonpenetrating tracheobronchial injuries: What is important in the mortality? J Cardiovasc Thorac Res. 2009; 1:5–8.