(0818) Improving Comfort Levels in Performing Awake Fiberoptic Intubation: A Collaborative Effort Between Otolaryngology and Anesthesia

Introduction: Awake fiberoptic intubation (AFI) is considered the “gold standard” for a difficult airway where relaxation may lead to a “cannot ventilate, cannot intubate” situation. Otolaryngology/anesthesia departments often work in conjunction when performing AFI. Many institutions have slight variations in protocols, which can create confusion when performing AFI. Having a standardized protocol has the potential to reduce errors.

Methods: This study was conducted from September 2022 to September 2024. An initial Zoom presentation was conducted amongst otolaryngology/anesthesia departments at a single institution, which involved creating a collaborative standardized protocol combining procedural methods from both departments. A survey inquiring about comfort levels in performing AFI amongst otolaryngology/anesthesia residents/attendings was distributed pre implementation of the protocol, 6 months post implementation and 10 months post implementation. Outcome measures included demographic data, comfort level in performing AFI and a comments section for why the protocol is or is not helpful.

Results: There were a total of 54 respondents amongst otolaryngology/anesthesia residents/attendings. Respondents were asked if they felt less, equally, or more comfortable 6 months after implementation of the protocol and results were 6%, 59% and 35%; respectively. Respondents were then asked this again 10 months post implementation and results were 0%, 53% and 47%; respectively. A comments section was also included in the survey and notable comments included: “would appreciate a hands-on learning session,” “having a protocol reduces errors,” and “the protocol adds consistency amongst providers."

Conclusions: Creating a standardized AFI protocol, in collaboration between otolaryngology/anesthesia departments, increased overall comfort levels in performing AFI amongst otolaryngology/anesthesia residents/attendings at this single institution. A standardized protocol is simple to implement and has the potential to increase comfort levels and reduce errors when performing AFI.