Date of this Version
Impact Statement: The purpose of this study is to educate the anesthesia team on the incidence of a difficult airway in patients with obstructive sleep apnea (OSA) and the STOP-BANG Questionnaire to predict this complication.
Background: Characterized by cessation of breathing during sleep due to collapse of the upper airway, patients with OSA possess a high risk of a difficult airway during anesthesia induction. During periods of constriction, the pharynx becomes obstructed, leading to adverse reactions such as desaturation, blood gas instabilities, abrupt arousal from sleep, and daytime fatigue. A needs assessment revealed that the STOP-Bang Questionnaire, the most validated screening tool for OSA, is not incorporated by anesthesia providers in clinical practice.
Method: Anesthesia personnel within the Broward Health system were asked to anonymously participate in an educational module, sent via email provided by the institution. Over the course of one month, anesthesia personnel completed an informed consent and prompted to complete a pre-evaluation examination on pathophysiology and assessment of OSA. Participants were then forwarded to a 13-minute educational video surrounding OSA, the STOP-BANG Questionnaire, and its relevancy in detecting difficult airways. When complete, the participants were asked to answer the same questions on the post-evaluation examination in effort to determine any increase in knowledge and participants willingness to change practice. Information is collected through an anonymous website, Qualtrics.
Results: There was an average improvement score of 50%, demonstrating the receptiveness of the educational module. More importantly, the likeliness of utilizing the STOP-Bang Questionnaire tool during their preoperative assessment increased from 67% more likely during the pre-test, to 100% more likely in the post-test.
Discussion: In the concluding assessment for participating anesthesia providers, an overwhelming amount contributors demonstrated not only an increase in knowledge, but a greater willingness to incorporate the STOP-BANG Questionnaire into the daily anesthesia patient assessment. Limitations within this quality improvement study include a small sample size was very small, only reaching six anesthesia providers, as well as holding the same pre-and post-evaluation examination questions. The STOP-BANG questionnaire can aid in alerting anesthesia providers of a potential OSA diagnosis and assist the provider in preparing for possible interventions. Potential anesthetic considerations for diagnosed or suspected OSA include minimal sedation, preparation for difficult mask ventilation and airway with glidescope and fiberoptic tools, pre-oxygenation with the head of the bed elevated, use of continuous positive airway pressure (CPAP), and cautious use of opioids.
Giroux, Blake A. MSN, RN; Alfonso, Fernando DNP, CRNA, APRN; and Body, Alexa DNP, CRNA, APRN, "Educating Anesthesia Personnel on STOP-BANG to Predict Difficult Airway" (2022). Nicole Wertheim College of Nursing Student Projects. 159.