Christopher M Frerk, MD
Consultant Anesthetist, Department of Anesthesia, Northampton General Hospital, Northampton, England, UK
Address correspondence and comments to Dr. Christopher M Frerk.
Published: July 23, 2000.
The correct citation of this report of a scientific meeting for reference is:
M Frerk. Difficult Airway Society Annual Scientific Meeting 1999 at
the Royal College of Physicians of Edinburgh. Internet Journal of
Airway Management 1, 2000-2001.
The Difficult Airway Society Annual Scientific Meeting 1999 was held in the Royal College of Physicians of Edinburgh (Edinburgh, Scotland, UK) from November 25 to 26, 1999, with more than two hundred delegates in attendance. The sessions included basic sciences, training issues, trauma and the airway, and debates on controversial issues surrounding airway management. There was also a very well attended free paper session.
Dr A Ovassapian (Chicago, Illinois, USA) - guest lecturer - gave an overview of airway management and how it might develop in the future. Many of the audience were already familiar with the themes of training and awake fiberoptic intubation, but Dr A Ovassapian’s ideas for the establishment of airway management societies and training centers and fellowships in airway management gave food for thought. An almost throw away comment that anaesthetists should not put up with second rate equipment received the biggest ovation of the conference - how many of us have forgotten that since we got back to our own hospitals?
Drs G Drummond (Edinburgh, Scotland) and P Charters (Liverpool, England) told us about what’s new in upper airway physiology and anatomy, notably that a major site of airway obstruction is at the level of the soft palate and explained why this was more likely in the presence of topical anesthesia and sedation. It makes you wonder if awake intubation is as safe as you think.
A session dedicated to training in airway skills demonstrated, amongst other things, that courses in fiberoptic intubation can be successful; fifty percent of delegates who had attended the Edinburgh course felt competent in the technique.
There were two lively debates. Dr I Calder (London, England) and Dr M Popat (Oxford, England) argued for and against the motion “teaching airway management on unconsented patients is unethical”. Dr A Pearce (London, England) and Dr D Gabbott (Gloucester, England) presented cases for and against the motion “the intubating laryngeal mask airway is a backward step”. All the speakers had put a lot of work into their presentations and their arguments were persuasive and entertaining. This section of the meeting was slightly let down by the disorganized voting system which meant that the society was unable to give a verdict on our opinion regarding these topics.
Trauma and the airway was covered from several angles including advanced trauma life support and burns and thermal injuries. Dr J Marais (Edinburgh, Scotland) gave a very enlightening talk demonstrating that iatrogenic laryngeal injury is not uncommon and that more pronounced injuries can prove very difficult to manage. It is our collective responsibility to try to discover what risk factors are involved and try to avoid them.
The free paper sessions were well attended. The presentations comprised the evaluation of a new flexible blade (Dr C Perera, Cardiff, Wales), the laryngeal mask versus the intubating laryngeal mask for resuscitation (Dr M Avidan, London, England; the printed publication appeared in the British Journal of Anaesthesia), the target controlled infusion of propofol for awake fiberoptic intubation (Dr P Kakodkar, Oxford, England), and a randomized controlled trial of learning fiberoptic skills (Dr S Benham, Oxford, England). Three clinical scenarios involving difficult airways were also presented during this session by Dr A Patel (London, England), Dr O Nafiu (West Suffolk, England), and Dr R McKinnon (Manchester, England).
Sometimes regarded as the poor relation at meetings, the poster presentation at this meeting was an exception. The winner of the poster prize Dr J Palmer (Dumfries and Galloway, Scotland) demonstrated that the cricoid cartilage is not quite as tough a ring as was once thought, and that complete airway obstruction can be caused by correctly applied cricoid pressure. This work has since been published in Anaesthesia and is worth reading in detail.
The final session of the conference reviewed equipment including the Henderson laryngoscope blade. It is possible that straight bladed laryngoscopy will be making a come back over the next 5 to 10 years and the introduction of this blade could be just the thing to get the momentum building up. Various projects were discussed including the difficult airway database, websites, and national guidelines for airway management.
The Annual General Meeting was held at the end of the first day at which time officers were elected and the formal business of the society was concluded. Our thanks go to Dr G Sharwood-Smith (Edinburgh, Scotland) for organizing the conference and to Mrs Cindy Middleton (Edinburgh, Scotland) for no doubt organizing Dr G Sharwood-Smith.
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