Anesthesia Change Management- Nasal Tse Pap -an example of change resistance psychology

Nasal Tse PAP- The most flexible and effective Nasal Route?

The Airway management world and anesthesia in particular now recognizes the advantages of nasal routes to oxygenation in management of challenging airway management. Change is now happening in spite of the culture of resistance. 

        There are now several strategies and techniques available including:

1. The time honored "NASAL CANNULA" strategy which has been ubiquitous but not used often historically during challenging airway encounters.-this is now being changed as the simplicity and effective use as an adjunct to pre oxygenation becomes recognized.

2. Naso Pharyngeal Cannulae have been recognized as useful to enrich oxygen distal to the nose in the pharynx. The work of Richard Levitan and Scott Weinberg repeatedly pressed the advantages of this strategy.

3. The successful development and commercialization of the " THRIVE " device has added a new strategy that is being shown to be effective by creation of "high flow nasal oxygen" induced CPAP with flow rates up to 70 L/min in adults.

4.  The conception and development of NASAL TSE PAP is , I believe , an example of systematic failure to seriously study and adopt a demonstrated and recognized optimal technology. Dr. James Tse , professor of Rutgers University department of Anesthesiology , has been demonstrating the effectiveness of nasal CPAP ( I call this NASAL TSE PAP in his honour) for perhaps 10 years. Recognition of the pivotal change possible with this teaching has been best recognized by an award from the Anesthesia Patient Safety Foundation a few years ago and by repeated awards at the PGA and ASA.

     The unique value of NASAL TSE PAP is that it is far more effective that ORO-NASAL mask in many situations because of the unique splinting of the airway during ventilation. Also the transition to positive pressure ventilation is at a Medical Student Level of difficulty. The reasons for neglecting this great contribution, that works seamlessly with Video Laryngoscopy in synchronous application, is based I believe on lack of scientific discipline.

    Change management in Anesthesiology is like a popularity contest which reminds me of the adoption of the Hula Hoop in popular culture.