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October 14, 2012
1:00:00 PM - 4:00:00 PM
Room Hall C-Area H
Usage Rates of Alternative Airway Devices in Adult Patients Presenting for Elective Surgery in American Teaching Hospitals: Clinical Experience From a Teaching Hospital
Davide Cattano, M.D.,Ph.D., Peter V. Killoran, M.D., Hassan Aijazi, M.B.,B.S., Carmen Seitan, M.A., Alfonso Altamirano, M.D., Carin A. Hagberg, M.D.
University of Texas Health Science Center Houston, Houston, Texas, United States
Modern airway management techniques are influenced by the availability of new devices.1 Technological advancements have resulted in a recent influx of a large number of these devices into clinical practice.2 We assessed the utilization of alternate airway devices (airway management devices beside the Macintosh and Miller laryngoscopes) at our institution, a large teaching tertiary care teaching hospital, Memorial Hermann Hospital-Texas Medical Center in Houston, Texas.

For this investigation, we analyzed data collected during a FAER funded study previously conducted at our institution. The FAER study was designed to assess the effect of a new airway assessment form on residents’ ability to predict difficult airways. Between 2008 and 2010, 9,103 post-operative outcome records were collected and entered into a data base. In this study, we analyzed that database to obtain information about the utilization rate of alternative airway devices at our institution. Data analyzed includes utilization rates of alternative airway devices, as well as their individual success rates. Information regarding the use of these devices as primary airway management tools, as opposed to rescue devices, is not available at this time.

The most commonly used alternative airway devices were oral fiberoptic intubation (OFOI)(n=318, usage rate=3.69%, first attempt success rate=92.5%), the Glidescope® video laryngoscopy system (Verathon Inc, USA) (n=223, usage rate=2.59%, first attempt success rate=95.5%), the Storz C-MAC® video laryngoscopy system (Karl Storz, Germany)( n=154, usage rate=1.79%, first attempt success rate=94.8%), the Aintree Intubation Catheter (Cook Critical Care, USA)( n=106, usage rate=1.23%, first attempt success rate=96.2%), Bougie (n=92, usage rate=1.07%, first attempt success rate=95.7%) and nasal fiberoptic intubation (NFOI)( n=92, usage rate=1.07%, first attempt success rate=85.9%). Among these devices, OFOI and NFOI were most likely to require multiple intubation attempts, while the other devices had relatively high rates of success on the first intubation attempt.

When comparing our results to a 2003 study conducted by Ezri et al.1, the most striking difference is the use of video laryngoscopes. These have been rapidly embraced as an important tool in the management of difficult airway situations.

The usage rate of these devices at our institution may be higher than at other institutions due to our special focus on teaching airway management skills, as some of these devices may have been used for teaching purposes rather than actual clinical necessity.


1. Ezri T, Szmuk P, Warters RD, Katz J, Hagberg CA. Difficult airway management practice patterns among anesthesiologists practicing in the United States: Have we made any progress? J Clin Anesth 2003; 15(6):418-22.

2. Hagberg CA, Greger J, Chelly JE, Saad-Eddin HE. Instruction of airway management skills during anesthesiology residency training. J Clin Anesth 2003; 15(2):149-53.

Copyright © 2012 American Society of Anesthesiologists