Near Perfection in Airway Management is now Possible #5

Fullfillment of the Andy Ovassapian Dream

The Society For Airway Management in 1995 was perhaps the crowning achievement of Andy Ovassapian in his quest for excellence in teaching and practise of Airway Management. 

Quote, Wood Library-Museum of Anesthesiology.

"In the 1970s, Dr. Ovassapian began using an endoscope to insert endotracheal tubes in patients where conventional techniques were difficult. By the early 1980s, he and his colleagues had established the first formal fiberoptic airway management teaching program for residents. In 1984, they also developed a workshop for practicing anesthesiologists. Dr. Ovassapian filed to patent the design for his intubating airway in 1988. In 1995, he founded the Society for Airway Management. Airway management refers to a broad number of techniques aimed at keeping an open pathway for air to move in and out of a patient's lungs."       .

Flexible Airway Endoscopy

      Andy was a rising force when the first flexible endoscopes were introduced to the medical world in the 1980s. He focussed early on this new equipment and continued teaching Flexible technique throughout his medical career. There was no doubt that Andy was the "Go to person" for evil airways . He applied the flexible scope technology in many original ways. When I first went to Chicago in 2002 to attend the Chicago Airway course ,Andy dropped by the Glidescope table and offered some fatherly advice to the upstart video laryngoscopy team from Saturn Biomedical. "Teach, teach , teach is the only way you are going to sell anything really new. Follow the example of Cook and LMA in the workshop world." 

       

     Teaching of the FOB and FOL were always a mystery to me, a Vascular and General Surgeon GI Endoscopist, who was often self taught as an endoscopist. The Anesthesia and ICU physicians appeared to stand back often when flexible endoscopy was required. The teaching 

studies demonstrated that while skills could be taught and retained by some the rate of loss of skills was very high as a rule. I thought at the time that this must have been a lifelong frustration for Andy who was a Wizard with the FOB and FOL. I then asked myself why so few practitioners were true experts in flexible endoscope use.  I concluded that opportunities for use were not great so students would need to exploit opportunities on a regular basis to build the skill and judgement so that it would be present when it was needed. Good equipment is required but it is expensive and takes a special dedication to overcome budget resistance. The equipment is not robust and many costly breakages occur. This all conspires against the general need for skill development.

Industry has played a great role in alleviating this problem by providing equipment for workshops for ED, Thoracic Anesthesia, and Flexible endoscopy workshops. The problem of flexible endoscopic skill development remains an unsolved one.

The establishment of an "Airway Lead" and an "Airway Rotation"are measures currently recommended as first steps.