Assessing CRNAs’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project

Abstract

Obesity (BMI > 30 kg/m2 ) has increased to over 40%, and morbid obesity (BMI > 40 kg/m2 ) to more than 9% of the United States population. Subsequently, there are more patients with obesity presenting for surgery and anesthesia. The increased adiposity in obese patients alters anatomy and physiology and places them at higher risk for difficult perioperative airway management. There are a variety of techniques to properly assess these risks, however no single source could be found that succinctly incorporated predictive scales for properly identifying and managing potential difficult airways in patients with obesity. The purpose of this Doctor of Nursing Practice quality improvement project was to assess CRNAs’ perception of a newly developed quick reference guide as a useful tool for their practice as it pertains to airway assessment in patients with obesity. The CRNAs used the provided quick reference guide for a period of two weeks and were surveyed before and after regarding their current assessment practices and patient populations. None of the providers reported using ultrasound in their assessments, despite receiving education of its high specificity and sensitivity in predicting difficult airways in patients with obesity and some CRNAs still reported patients with obesity are more difficult to intubate, which contradicts current literature. Limitations to this project are the small sample size and unequal pre- and post-implementation survey responses. Knowledge gained from this pilot project could be used in future quality improvement and policy efforts aimed at improving anesthesia care of patients with obesity.