Study objectives This study was designed to evaluate how the anesthesiologists in Cairo University Hospitals are adherent in their practice to the latest ASA guidelines for management of difficult airway in order to stand on the current status and establish a basis for improvement. Methods This is a survey study included 190 anesthesiologists from the faculty members of Cairo university hospitals. All of them completed the study questionnaire. Main results A 77.9% of the responders admitted their use of the ASA Algorithm during their practice. For anticipated difficult airway, 74% would employ regional anesthesia as first choice while 52% and 54% would use Supraglottic airway devices and awake Fiberoptic respectively. For unanticipated failed intubation with adequate mask ventilation, 90% would use a supraglottic airway device as their first choice while 85% and 90% would wake up the patient, perform awake fiberoptic intubation and make an emergency invasive airway access respectively. For failed intubation with difficult/impossible mask ventilation, 87% would use a supraglottic airway device while 51% and 28% would perform needle cricothyroidotomy and percutaneous tracheostomy respectively. Awake fiberoptic intubation and intubation with direct laryngoscope using intravenous induction and succinylcholine were the most frequently used techniques in different clinical scenarios. Conclusion The practice of anesthesiologists in Cairo university hospitals is close to the recommendations of the ASA guidelines for management of difficult airway. There is increased skills in fiberoptic bronchoscopes and SGA with increased frequency of difficult airway managements training courses; however, they need to improve their skills in awake fiberoptic intubations technique and they need to be trained on invasive airway management access to close the discrepancy between their theoretical choices in different situations and their actual skills.
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