Open Access Research article

A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden

Kati Knudsen12*, Ulrika Pöder1, Marieann Högman34, Anders Larsson5 and Ulrica Nilsson6

Author Affiliations

1 Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Box 564, Uppsala, SE 751 22, Sweden

2 Department of Health and Caring Sciences, University of Gävle, Gavle, SE 801 76, Sweden

3 Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, SE 751 85, Sweden

4 Centre for Research & Development, Uppsala University/ County Council of Gävleborg, Gavle, SE 801 88, Sweden

5 Department of surgical sciences, Uppsala University, Anaesthesiology & ICM, Uppsala SE 751 85, Sweden

6 School of Health and Medical Sciences, Örebro University, Örebro SE 701 82, Sweden

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BMC Anesthesiology 2014, 14:25  doi:10.1186/1471-2253-14-25

Published: 7 April 2014



In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.


A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.


In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.


Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

Airway guidelines; Airway management; Patient safety