MD Wittenberg
AJ Wickham
RJ Daly
DJA Vaughan
DN Lucas
Department of Anaesthesia, Northwick Park Hospital, London, UK
Simulator-based assessment of an airway checklist in obstetric anaesthesia
Introduction
The fourth National Audit Project recommended that a simple airway checklist based
around preparation of the patient, equipment and drugs, staff and for potential
difficulty can identify potential problems in a very short time. However, concerns have
been raised that use of a checklist in the obstetric setting may prolong time to general
anaesthesia (GA) in an already pressurised situation.
We designed a checklist for use prior to administering a GA for caesarean section, and
used high fidelity simulation to examine the procedural time and efficacy of the
checklist.
Results
•The difference in mean ± SD time taken from decision for GA to intubation when
not using the checklist (N-GA) and using the checklist (C-GA) was not statistically
significant between the groups (4.95±2.9 4 min vs 4.76±1.41 min; P=0.87).
•There was no significant difference in time from start of pre-oxygenation to
intubation between the groups (3.98±0.85 min vs 3.29±1.05 min; P=0.3)
•100% of users found the checklist useful and 66% felt that it helped them with
decision making.
12
10
8
6
4
2
• 44% of users found that it reduced their anxiety (figure 2).
Time
(mins)
0
Reference
1. Cook TM, Woodall N, Harper J, Benger J. Major Complications of Airway Management in the UK: Results of the Fourth National Audit Project of the Royal
College of Anaesthetists and the Difficult Airway Society. Part 2: Intensive Care and Emergency Departments. Br J Anaes. 2011; 106 (5): 632–642.
30%
20%
10%
Did you find the
checklist useful?
Not at all
Not much
Somewhat
Definitely
Not at all
Not much
Somewhat
Definitely
0%
Not at all
A questionnaire was given to assess the candidates’ perception of the usefulness of the
checklist and reduction of anxiety.
40%
Not much
•We now intend to introduce the checklist to routine practice to evaluate its impact in
a clinical setting.
50%
Somewhat
•Participants felt that using the checklist reduced error and anxiety in this setting.
60%
Definitely
•The simulator is a safe and effective method of evaluating human factors and the
impact of checklists.
70%
Not at all
A high fidelity 3G Laerdal SimMan was used and theatre set-up, drugs and anaesthetic
equipment was similar to that in the labour ward. Times from decision for GA, and
from start of pre- oxygenation, to successful tracheal intubation were recorded. Data
were compared using the paired t-test.
•We found that using an airway checklist for obstetric GA in a simulator setting did not
cause significant delay in successfully intubating the trachea.
N-GA: Time from start C-GA: Time from start
of preoxygenation to of preoxygenation to
intubation
intubation
80%
Not much
Each team conducted two different scenarios, simulating an obstetric emergency that
required the administration of a GA. The first scenario was conducted without the use
of the checklist and the second scenario was conducted with the checklist, during preoxygenation, following brief instruction by the lead investigator.
Discussion
C-GA: Time from
decision for GA to
intubation
Figure 1: Times from decision for GA and start of pre-oxygenation to intubation when using (C-GA)
and not using (N-GA) the checklist.
Somewhat
Following Caldicott guardian approval and written informed consent, we recruited nine
anaesthetists and nine anaesthetic assistants with competencies in obstetric
anaesthesia.
Definitely
Methods
N-GA: Time from
decision for GA to
intubation
Did it help you with
Do you think it
Do you think that it
decision-making? delayed time to GA?
made you less
anxious?
Figure 2: Outcome of questionnaire of users’ perception of using the checklist