Training in fibreoptic intubation – 2

In response to Ahmad and Bailey's editorial 1, we agree with Ward that opportunities for training in awake fibreoptic intubation are limited in the UK. At our 860-bed hospital, for example, there are 33 permanent anaesthetists plus seven trainees. According to Royal College training guidelines, we calculate 27 fibreoptic intubations would need to be carried out by just the trainees annually to achieve ‘competence’, let alone maintenance of skill by trainees or consultants. In fact, just 17 fibreoptic intubations were performed last year, even though routine Ear, Nose and Throat and Maxillofacial surgery is undertaken at our hospital. Six of these procedures were performed out-of-hours and so were not ‘taught’ episodes. We have no reason to believe our practice differs significantly from similarly-sized hospitals. If videolaryngoscopy becomes increasingly used for managing the unanticipated difficult airway, how are trainees expected to learn and maintain skill in fibreoptic intubation? Some hospitals practice the technique on patients who could be managed with conventional laryngoscopy 2, although the ethics of this have been challenged 3. Dedicated airway programs, combining simulation and clinical training, have been proposed 4, as have ‘practice on your peers’ workshops. If the profession decides to abandon fibreoptic bronchoscopy altogether, as Ahmad and Bailey suggest, then curriculums, protocols and training programs will need to accommodate this change in practice to ensure we continue to deliver optimal airway management.