Abstract
BACKGROUND: Difficult airways (i.e., when a healthcare provider with skills in airway management encounters difficulties when using recognized techniques) require proper training (or supervision), experience, risk assessment, and clinical judgment, but the knowledge, attitude, and practice (KAP) of Chinese anesthesiologists toward difficult airways is poorly known. This study aimed to remedy that problem. METHODS: This cross-sectional study enrolled Chinese anesthesiologists from September 1, 2023, to November 30, 2023. The KAP toward difficult airways was assessed using a questionnaire (Cronbach's α = 0.705). Scores ≥ 85% indicated good/positive/proactive knowledge/attitudes/practice, 50-75% were moderate, and < 50% were poor. The factors associated with practice were identified by multivariable logistic regression. RESULTS: A total of 992 questionnaires were included. The participants were 39.89 ± 8.46 years, 52.72% were male, 79.13% were working in tertiary hospitals, and 19.96% had 6-10 years of experience in anesthesia. The mean knowledge, attitude, and practice scores were 18.09 ± 2.46 (69.58% of the maximum), 32.22 ± 2.77 (92.06% of the maximum), and 63.80 ± 5.54 (85.07% of the maximum), respectively. 97.18% of anesthesiologists reported that they frequently assess all patients for the risk of difficult airway and aspiration prior to anesthesia administration or airway management. Notably, however, 30.14% of doctors indicated that they may not confirm the availability of difficult airway equipment in the operating room if the patient has not been evaluated as having a difficult airway. Furthermore, only 41.93% of anesthesiologists reported being able to successfully use awake fiberoptic intubation when managing a difficult airway on a frequent basis. The high attitude scores (Odds Ratio [OR] = 1.234, 95% Confidence Interval [CI]: 1.164-1.307, P < 0.001), master's degree or above (OR = 2.262, 95%CI: 1.539-3.323, P < 0.001), and participated in training on difficult airway assessment and management in the past 6 months (OR = 1.943, 95%CI: 1.388-2.720, P < 0.001) were more likely to achieve higher practical scores. After adjustment, the SEM showed that knowledge directly influenced attitude (β = 0.338, P = 0.011) but not practice (P = 0.637); attitude directly influenced practice (β = 0.584, P = 0.003). CONCLUSION: Anesthesiologists in China have favorable KAP toward difficult airways. Nonetheless, certain practices require enhancement. Since knowledge is associated with attitude and attitude with practice, educational and motivational activities should be designed to improve practice. CLINICAL TRIAL NUMBER: not applicable.