Airway management is a critical aspect of anesthesia practice and plays a pivotal role in ensuring patient safety during surgical procedures. The ability to establish and maintain a patent airway is fundamental for delivering adequate oxygenation and ventilation to patients while they are under the influence of anesthesia. In the picturesque state of Himachal Pradesh, where natural beauty thrives in harmony with the pursuit of healthcare excellence, Resident Anesthetists shoulder the responsibility of mastering the intricate art and science of airway management. This study embarks on a journey to assess the levels of awareness and knowledge among these residents concerning airway management techniques, specifically focusing on intubation, mask ventilation and the use of supraglottic airway devices [1,2].

The process of airway management encompasses a range of techniques and skills aimed at ensuring the unobstructed flow of air into and out of a patient's lungs. Among these techniques, intubation stands as a cornerstone, involving the insertion of an endotracheal tube into the trachea to establish a secure airway. This technique is essential during various surgical procedures, especially when the patient's airway needs to be protected and controlled. Equally important is mask ventilation, a skill that enables manual ventilation using a facemask and is often employed during the induction of anesthesia or in situations where intubation may be challenging or contraindicated. Complementing these techniques is the use of supraglottic airway devices, which have gained prominence in recent years. Supraglottic airway devices provide a means of maintaining a patent airway without the need for tracheal intubation and are particularly useful in scenarios where traditional intubation may be difficult [3-5].

The proficiency of Resident Anesthetists in comprehending, executing and adapting these airway management techniques is paramount to the success of surgical procedures and patient well-being. Any inadequacies or gaps in their knowledge and skills can have a direct impact on patient safety and surgical outcomes.

This study aims to evaluate the knowledge and awareness levels of Resident Anesthetists in Himachal Pradesh regarding intubation, mask ventilation and the use of supraglottic airway devices. By assessing their understanding of the principles, procedures and potential complications associated with these techniques, we aim to identify areas that may benefit from further education and training.

Objectives of the Study

The primary objective of this study is to gauge the levels of awareness and knowledge about airway management techniques, including intubation, mask ventilation and the use of supraglottic airway devices among the Residents of Anesthesia in Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: Himachal Pradesh

• Study duration: Between April 2023 to June 2023

• Study population: The study's target population encompassed all Junior and Senior Residents of Anesthesia working in Medical Colleges in Himachal Pradesh.

• Sample size: A robust sample size of 100 was determined using a 95% confidence level, an estimated knowledge level of 50% regarding airway management techniques, a precise 10% absolute error margin and a conservative 5% non-response rate

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding airway management techniques was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion etc

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding airway management techniques. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of tool: By the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among all the Junior and Senior Residents of Anesthesia working in Medical Colleges in Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 100 responses were collected

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The primary objective of this study was to gauge the understanding of airway management techniques, including intubation, mask ventilation and the use of supraglottic airway devices among the Residents of Anesthesia in Himachal Pradesh. A total of 100 participants took part in the study (Table 1).

Table 1: Knowledge Regarding Airway Management Techniques Among Study Participants

Table 2: Knowledge Scores Towards Airway Management Techniques Among Study Participants

In the present study 21 participants had very good knowledge (16-20 marks) towards airway management techniques, 35 had good knowledge (12-15 marks), 24 had fair knowledge (8-11 marks) and 20 having poor knowledge (<8 marks) (Table 2).

Airway management is a fundamental and critical component of anesthesia practice, as it directly influences patient safety during surgical procedures. In the scenic state of Himachal Pradesh, where the pursuit of healthcare excellence coexists with natural beauty, Resident Anesthetists are entrusted with the responsibility of mastering the intricate art and science of airway management. This study sought to assess the knowledge and awareness levels of these residents regarding key airway management techniques, including intubation, mask ventilation and the use of supraglottic airway devices. The results shed light on the proficiency of Resident Anesthetists in Himachal Pradesh and offer insights into areas where further education and training may be beneficial.

In the realm of airway management, intubation is a cornerstone skill. It was encouraging to note that a substantial proportion of participants demonstrated a clear understanding of the primary goal of airway management in anesthesia, which is to ensure adequate oxygenation and ventilation while maintaining a patent airway. Furthermore, participants displayed familiarity with the indications for endotracheal intubation during surgery, emphasizing the importance of protecting and controlling the patient's airway in specific clinical scenarios. While many participants could describe the steps for performing endotracheal intubation, there is an opportunity for refinement, particularly in ensuring consistent adherence to best practices and minimizing complications associated with intubation. Awareness of the advantages and disadvantages of endotracheal intubation was noteworthy, as it underscores the importance of selecting the most appropriate airway management technique for each patient's unique circumstances [2-4].

Mask ventilation (bag-mask ventilation) is a crucial skill, especially during the induction of anesthesia or when intubation may be challenging. Participants exhibited a solid grasp of when mask ventilation should be employed during anesthesia. However, there is room for improvement in their understanding of the key considerations for effective mask ventilation, which is essential for ensuring proper oxygenation and ventilation and preventing complications. Supraglottic airway devices represent a valuable addition to airway management techniques and participants in this study demonstrated awareness of their indications and contraindications. While participants could describe the steps for inserting a supraglottic airway device like the laryngeal mask airway (LMA), further emphasis on proper placement confirmation is warranted. This is critical for avoiding complications and ensuring the device's effectiveness [3,4].

Complications and challenges in airway management were topics where participants exhibited commendable awareness, recognizing the potential issues that may arise during intubation or airway management and how to address them. Understanding the differences between a difficult airway and a failed airway is crucial for making timely decisions and providing appropriate interventions. While participants could describe various techniques and tools for managing a difficult airway, continuous training in this area remains essential. The concept of rapid sequence induction, its relevance to airway management and the importance of teamwork and communication in airway management during surgery were areas where participants demonstrated a solid understanding. These elements are vital for ensuring patient safety and successful outcomes [4,5].

Comparing these findings with existing literature on airway management knowledge among anesthesia residents, this study aligns with prior research in identifying varying levels of knowledge and proficiency. These results emphasize the need for ongoing education and training programs to enhance the competence of Resident Anesthetists.

In conclusion, this study provides valuable insights into the knowledge and awareness levels of Resident Anesthetists in Himachal Pradesh regarding airway management techniques. While participants exhibited commendable proficiency in several aspects of airway management, there exist specific areas that warrant further attention and training. These findings underscore the importance of continuous educational initiatives to enhance the competence of Resident Anesthetists, ultimately contributing to improved patient safety and healthcare standards in the captivating landscapes of Himachal Pradesh.

1. Cook, T.M. et al. “Simple airway management devices.” Continuing Education in Anaesthesia, Critical Care and Pain, vol. 15, no. 5, 2015, pp. 218–223. https://doi.org/10.1093/bjaceaccp/mkv006

2. Mort, T.C. “The History of anesthesia: Introduction.” History of Anesthesia: The Third International Symposium, Springer, 2018, pp. 3–11. https://doi.org/10.1007/978-3-319-68762-9_1

3. Pandit, J.J. et al. “The difficult airway society ‘ADEPT’ guidance on selecting airway devices: The basis of a strategy for equipment evaluation.” Anaesthesia, vol. 74, no. 6, 2019, pp. 793–800. https://doi.org/10.1111/anae.14697

4. Benumof, J.L. and M.S. Scheller. “The importance of training to achieve competence for airway management: Working toward safe patient care and zero morbidity.” Anesthesiology, vol. 124, no. 2, 2016, pp. 370–371. https://doi.org/10.1097/ALN.0000000000000972

5. Higgs, A. et al. “Guidelines for the management of tracheal intubation in critically ill adults.” British Journal of Anaesthesia, vol. 120, no. 2, 2018, pp. 323–352. https://doi.org/10.1016/j.bja.2017.10.021