Investigation Of Current Status Of Difficult Airway Notification And Research On Writing Of Difficult Airway Letter In The Plastic Surgery Hospital

Background:Perioperative difficult airway management is a huge challenge that anesthesiologists often face in clinical work.In recent years,with the development and application of difficult airway management tools,the formulation of difficult airway management guidelines,and the importance and extensive development of airway management training,the incidence of difficult airway has decreased significantly,but serious airway complications and even death caused by the failure of airway management still occur.It has been confirmed that comprehensive preoperative airway assessment can effectively prevent the occurrence of unanticipated difficult airway.Therefore,improving the preoperative airway assessment system is one of the important measures to ensure the perioperative airway safety of patients which cannot be ignored.The difficult airway letter is that the anesthesiologists inform the patient and his family of the evaluation and treatment of the patient’s difficult airway in written form,and tell them to keep it properly so that the difficult airway management information will be effectively passed to the airway management related medical staff when the patient is admitted to hospital,so as to provide the most direct and beneficial guarantee for improving the preoperative airway assessment and ensuring airway safety.At present,the United States,Canada and other countries have established comprehensive difficult airway notification system,and the difficult airway letter has been widely used throughout the country.However,in China,there has not yet been a systematic and comprehensive difficult airway notification system,and there is a lack of investigations on the status of difficult airway notification,what’s more,there are few studies on establishing a difficult airway notification system and writing difficult airway letter.Therefore,it is necessary to further explore and study the necessity and feasibility of establishing difficult airway notification system in China and how to construct the difficult airway letter writing mode suitable for China’s national condition.Objective:1.To investigate the current status of difficult airway notification in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences,and discuss the necessity and feasibility of establishing difficult airway notification system and writing difficult airway letter in China.2.To explore the mode for writing difficult airway letter that suits China’s national condition based on the difficult airway notification system that has been established in foreign countries.3.To promote the establishment and development of the difficult airway notification system in China,and further ensure the airway safety of patients during the peri-operative period.Methods and Results:Part One:The investigation of current status of difficult airway notificationMethods:Produce difficult airway notification questionnaires for anesthesiologists,surgeons,and patients,then distribute the questionnaires to the patients who will undergo surgical treatment at the plastic surgery hospital,anesthesiologists,and plastic surgeons,questionnaires will be distributed on the spot by the investigator and retrieved after being filled out by respondents.Collectively analyze the questionnaires.All completed questionnaires are determined to be valid questionnaires,questionnaires with missing or multiple-choice are considered invalid questionnaires;Use Excel2013 to perform data entry on the results of valid questionnaires,use SPSS25 software to perform statistical analysis.Results:Investigation of patients with difficult airway notification status:446 effective questionnaires show that 59.19%of patients did not understand the definition and risk of difficult airway at all.89.46%of patients thought it was very necessary for anesthesiologists to inform them of the difficult airway after operation.91.03%of patients thought that it was very necessary for the anesthesiologists to provide them with a difficult airway letter fully documented airway condition and management.95.96%of patients are willing to definitely inform the relevant medical staff of the difficult airway condition before the next operation.Investigation of surgeons with difficult airway notification status:148 valid questionnaires show that 83.78%of surgeons generally understand the definition and danger of difficult airway;if the patient is difficult airway,91.22%of surgeons believe that it is very necessary for the anesthesiologists to orally inform the patient with the surgeons,77.03%of the surgeons believe that it is very necessary for the surgeons to complete the difficult airway letter with anesthesiologists after operation which will help them fully understand the difficult airway;71.62%of surgeons believe that the difficult airway letter will not affect their clinical work,but will help them better understand the patients and ensure the safety of patients during the perioperative period.Investigation of anesthesiologists with difficult airway notification status:34 valid questionnaires show that during preoperative visits,55.88%of the anesthesiologists said that less than 5%of the patients would provide them with information about difficult airway management of previous surgery.76.46%of anesthesiologists believed that the current way for domestic patients to obtain information about difficult airway management related to previous surgery is mainly verbal or written notification by anesthesiologists;For the previously treated difficult airway,64.70%of the anesthesiologists said that the number of patients who had been orally informed about difficult airway management after surgery was less than 50%;Regarding the necessity for difficult airway notification after surgery,91.18%of anesthesiologists consider it necessary to inform patients of difficult airway management related information after surgery in oral way,97.06%of anesthesiologists consider it necessary to inform patients of difficult airway management related information after surgery in writing,and 91.18%of anesthesiologists consider it necessary to complete a written difficult airway letter with the surgeons.Regarding the reasons for the anesthesiologists’unwillingness to inform the patient of the difficult airway information,34.69%of the anesthesiologists believe that there are no hard rules or requirements to inform,18.37%of the anesthesiologists think that the verbal/written notification increases their workload,16.33%of anesthesiologists do not know how to inform,12.24%of anesthesiologists are concerned that difficult airway notification would expose their misjudgments and improper handling in airway management.Investigation of different status groups with the necessity for verbal/written notification about difficult airway related information to patients:Investigation of patients,surgeons,and anesthesiologists with the necessity for verbal notification about difficult airway show no statistical difference(P>0.05),and they unanimously believed that it is necessary to inform the patient verbally about difficult airway evaluation and treatment process after operation.Investigation of patients,surgeons,and anesthesiologists with the necessity for written notification about difficult airway showed statistical difference(P<0.05);Compared with surgeons,more patients and anesthesiologists believe that it is necessary to inform the patient in writing about the difficult airway condition and treatment process after operation.Part Two:The research on writing of difficult airway letterMethods:Refer to the written format and content of the difficult airway letter in the "The difficult airway with recommendations for management-Difficult tracheal intubation encountered in an unconscious/induced patient" issued by the Canadian Airway Focus Group(CAFG)in 2013 and the "The guidelines for the management of unanticipated difficult tracheal intubation in adults" issued by The All India Difficult Airway Association(AlDAA)in 2016,as well as the difficult airway notification system that has been established in the United States,combined with the current situation of perioperative difficult airway management in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences,compile difficult airway letter in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences.Results:Completion of difficult airway letter applicable to the difficult airway management system of the Plastic Surgery Hospital of the Chinese Academy of Hospital Sciences.Conclusion:1.At this stage,patients do not have enough knowledge about difficult airway,however, they have a strong willingness to be informed of the evaluation and management of difficult airway verbally and in writing;What’s more,they are willing to inform the relevant medical staff of the difficult airway condition before the next operation in order to ensure their perioperative airway and life safety.2.Plastic surgeons have a certain level of knowledge about difficult airway;Most plastic surgeons consider it necessary to inform patients of difficult airway information and are willing to complete difficult airway letter with anesthesiologists.3.Before the operation,anesthesiologists have very limited information about difficult airway in previous surgery from patients.4.Currently,anesthesiologists do not know much about the difficult airway notification system;even in plastic surgery hospital with a relatively high incidence of difficult airway,only a small number of anesthesiologists have verbally informed patients about difficult airway management after the operation.5.In order to better ensure the airway and life safety of patients during the perioperative period,most anesthesiologists are willing to inform patients about their difficult airway management verbally/in writing after the operation,and are willing to complete the difficult airway letter with the surgeons.6.The results of the questionnaires analysis of patients,surgeons,and anesthesiologists show that it is necessary and feasible to implement the difficult airway notification system and write the difficult airway letter.