The preferred airway for dento-alveolar procedures—a postal survey of UK oral and maxillofacial surgeons

Background: Dento-alveolar procedures under a general anaesthesia are commonly carried out in the secondary care setting. The choices for airway management for this type of surgery include the laryngeal mask (LMA), oral endo-tracheal tube (OETT) and the nasal endo-tracheal tube (NETT).

Aims: To investigate the influencing factors and preference for the choice of airway in the UK dento-alveolar surgery practice and scrutinise the use of throat packs and bite packs and the policies relating their safe removal. Method Postal questionnaires were sent to all individual UK consultants from the list of oral and maxillofacial hospital units provided by the British Association Oral Maxillofacial Surgeons (BAOMS). A stamped addressed envelope was enclosed and a moral incentive was offered in order to increase the response rate. The use and/or preference for a specific airway was analysed for specific procedures such as surgical extraction of wisdom teeth, multiple extractions/dental clearance and surgical exposure and bracket bonding of un-erupted canines. The perceived surgical difficulty, anaesthetic preference, operating surgeon’s experience and airway safety concerns were criteria that guided the preference for the choice of a particular airway.

Results: For the extraction of wisdom teeth 57%, 33% and 10% of the surgeons preferred LMAs, NETT and OETT respectively. The main factors influencing the surgeons’ choice for a particular airway for to dento-alveolar surgery were: perceived surgical difficulty (32%), airway safety (28%), anaesthetist preference (24%) and operator experience (16%). 30% of the surgeons surveyed do not use throat packs. When throat packs were used they were routinely inserted by anaesthetists in 71% cases.

Conclusion: This survey provides an analysis of the main factors influencing the management of airway for dento-alveolar surgery. The use of LMA has become widespread. Surgeons who use throat packs also reported associated safety checks to ensure their removal after surgery.

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on The preferred airway for dento-alveolar procedures—a postal survey of UK oral and maxillofacial surgeons
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