Best practice airway management clinical reference tool for bariatric patients and morbid obesity
Creators: name: Nolan, Terrence
Publisher: name: No Publisher Supplied
Year: 2023

description: AbstractPurposeAirway management and assessment are the cornerstones of modern anesthesia practice. Obesity is a well-known risk factor in identifying patients with potentially complicated airways. In addition, morbidly obese patients have clinically significant reductions in functional residual capacity (FRC) that can lead to precipitous decreases in oxygen saturation during periods of apnea. Despite the knowledge of these details, there is a large variation in how anesthesia providers care for these patients. This quality improvement project sought to see if an educational presentation that presented a clinical reference tool via internet access would change how likely anesthesia providers are to use adjuncts with bariatric or morbidly obese patients. Methodology The investigators in this study conducted an educational intervention with a private practice anesthesia group. Investigators enrolled 17 subjects and conducted a pre-test survey. After collecting pre-test data, subjects were introduced to an educational presentation and a clinical reference tool highlighting the benefits of video laryngoscopes, aspiration prophylaxis, and ramped positioning with bariatric patients. This information was distributed via power point as well as made available online continuously at www.rampglideandreglan.com. After the distribution of the educational materials and knowledge sharing of published resources emphasizing the benefits of using adjuncts with bariatric patients. A post-test survey using a 5-point Likert scale was distributed to assess likely hood of using aspiration prophylaxis, ramped positioning, and video laryngoscopes, as well as a qualitative question assessing whether participants found the tool helpful and what improvements they might suggest. ResultsUsing SPSS V28 statistical software, descriptive statistics were run on the pre and post-survey scores, with a mean score of 13.5 vs. 17.6, showing providers' willingness to change their practice. A paired t-test was also conducted since the pre and post-test data was linked. A Wilcoxon signed-rank test showed that the subject's likelihood of using suggested changes in airway management was significant (P&lt;0.05). ImplicationsThe data collected from this study demonstrates that anesthesia providers do not follow a uniform method of airway management while taking care of morbidly obese patients. After the researchers implemented their education with clinical reference tool a post-test survey was conducted that demonstrated a willingness to utilize adjuncts such as ramping, videoscopes, and aspiration prophylaxis as measured by a 5-point Likert scale. The results were statistically significant, and suggest that anesthesia providers are willing to use incorporate more up-to-date practices when provided sufficient education and clinical reference tools to supplement their knowledge deficit. KeywordsAnesthesia, morbidly obese, airway management, ramping, aspiration prophylaxis, video laryngoscopy, glidescope, Reglan, intubation, best practice, clinical reference tool, obesity.