Introduction

 

Andranik Ovassapian (from the Anesthesia Service of the Veterans Administration Lakeside Medical Center, affiliated with the Anesthesia Department of the Northwestern University School of Medicine in Chicago, Illinois, United States) early recognized the potentials that flexible fiberoptic bronchoscopes (FFBs) offered to improve airway management and soon acquired an extensive experience in their use. He observed a high failure rate when FFBs were introduced into anesthetic practice for performing tracheal intubation, particularly in difficult situations. Unsatisfactory attempts of flexible bronchoscopy-assisted (FBA) tracheal intubation (without prior training and experience in patients with normal airways) led to repeated dissapointments in the use of this innovative technique.

In order to overcome this problem, Ovassapian initiated a structured training program (based on sound educational principles) for teaching FBA tracheal intubation and airway evaluation (with prior practice on a bronchoscopy teaching model before performance on patients) already in the year 1978. He was impressed by the publication of Howells and co-workers (6) who used an airway model for training of conventional orotracheal intubation. Medical students with prior practice on the model demonstrated more skills and confidence and achieved a higher success rate when performing their first attempts of tracheal intubation on patients than those who did not had this practice.

The early published reports on FBA tracheal intubation were based on the overwhelming preference for the nasal route, frequently performed in awake patients using topical anesthesia (16); these and his own experiences markedly influenced the initial training program (11, 12). This program, primarily dedicated to train anesthesia residents, was later incorporated into a workshop format, first organized in 1984, for training of practising anesthestists from other departments (2).
 

 

Early Experiences with Training Programs