How controversial are anesthetic controversies?

STUDY

OBJECTIVES

To determine how controversial the management of a number of clinical scenarios that are labeled as controversial (eg, how to induce anesthesia in the "open eye-full stomach" patient) are among those practicing anesthesia.

DESIGN

Written survey.

SETTING

A national anesthesiology review course.

SUBJECTS: 575 anesthesiologists attending the review course.

INTERVENTIONS: Anesthesiologists were presented 11 scenarios regarding some specific controversies in anesthetic management; each scenario also described a suggested course of management. Two questions were asked for each scenario: "Is this acceptable practice?" and "Would you do this in your own practice?" The scenarios included using succinylcholine for an "open eye-full stomach" patient, not evaluating preoperatively the cardiac status of a patient after receiving adriamycin therapy, using triggering drugs after a negative muscle biopsy for malignant hyperthermia, ordering a pregnancy test preoperatively for all females of child-bearing age, and seven others.

MEASUREMENTS AND MAIN

RESULTS

For each scenario, comparisons between the number of respondents who felt a particular management was acceptable practice and the number who would do this in their own practice were made using chi-square analysis; p < or = 0.05 was considered significant. 160 (27.8%) surveys were returned. In ten scenarios, there was 70% or less agreement about whether a technique was acceptable. In six scenarios, there was a significant difference between the number of respondents who felt a suggested management was acceptable practice and the number who would use it in their own practice.

CONCLUSIONS

This survey of anesthesiologists regarding these controversial clinical scenarios showed that (a) most scenarios were in fact controversial amongst those in practice, and (b) there were disparities between whether a technique is believed to be acceptable practice and whether it would be used in one's own practice.