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

Abstract

Obesity is a growing health concern and increases the risk of a difficult airway. Recent evidence indicates a combination of airway assessment techniques may be most effective in predicting difficult airways in patients with obesity, but determining which combination to use is difficult. The purpose of this project was to assess the perceptions of adequacy of the quick-reference guide format as a useful tool for CRNA practice when assessing the airways of patients with obesity. A literature review was conducted to identify the airway assessment techniques that are most accurate in predicting difficult airways in patients with obesity. Then, a quick-reference guide was created to present these techniques together. Ten CRNAs were asked to complete a pre-implementation survey, use the quick-reference guide for two weeks, and complete a post-implementation survey. Comparison between the pre- and post-implementation surveys showed that perceptions of usefulness of the STOP-Bang score, Mallampati score, and thyromental distance increased during the project. Perceptions of usefulness of neck circumference and thyromental distance to neck circumference ratio changed little. Overall perceptions of usefulness of the quick-reference guide were moderate. The results from this project could indicate that a quick-reference guide may act as a helpful addition to the pre-anesthetic assessment. However, this project was conducted for a short period of time with few participants, so further investigation needs to be conducted to better understand what alterations to the quick-reference guide may improve utility.