Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress?

To determine the extent instruction and practice in the use of airway devices and techniques varies among anesthesiologists practicing in the United States. Survey questionnaire. University medical center. Questionnaires were completed by American-trained anesthesiologists who attended the 1999 American Society of Anesthesiologists (ASA) Annual Meeting. Data collected included demographics, education, skills with airway devices/techniques, management of clinical difficult airway scenarios, and the use of the ASA Difficult Airway Algorithm. 1) Demographics: 452 questionnaires were correctly completed; 62% attending anesthesiologists, 70% 10 years of practice, 81% night duty, 77% board certified. 2) Education: 71% had at least one educational modality: difficult airway rotation, workshops, conferences, books, and simulators. 3) Skills: Miller blade 61%, Bullard laryngoscope 32%, LMA™ 86%, Combitube™ 43%, bougie 43%, exchangers 47%, cuffed oropharyngeal airway (COPA) 34%, retrograde 41%, transtracheal needle jet ventilation 34%, cricothyrotomy 21%, fiberoptics 59%, and blind nasal intubation 78%. The average reported use of special airway devices/techniques was 47.5%. 4) Management choices: failed intubation/ventilation: LMA™ (81%) and for all other situations: fiberoptic intubation. Use of ASA Difficult Airway Algorithm in clinical practice (86%). Fiberoptic intubation and the LMA™ are most popular in management of the difficult airway.