AB276. SOH26AB_0162. Development of an awake tracheal intubation guide and medication dosing tool for use at University Hospital Limerick

Background: Awake tracheal intubation (ATI) is a core strategy in the management of the anticipated difficult airway. Difficult Airway Society (DAS) guidelines recommend the use of cognitive aids, such as a checklist, before and during performance of ATI, and that the maximum dose of local anaesthetic (LA) should not exceed 9 mg/kg lean body weight. ATI may be associated with the most operator-related psychological stress of all airway management interventions. Appropriate preparation will mitigate the risk of complications and failure. This was highlighted in the 4^th national audit project (NAP4), which recommended that all anaesthesia departments have the skill and equipment readily available for ATI. We aimed to generate a guide for ATI and a medication dosing tool.

Methods: We reviewed the contents of our ATI trolley and created a user-friendly guide containing our DAS ATI guidelines, equipment checklist, sedation protocols, and developed a topicalization dose tool to prevent toxicity.

Results: The resulting guide is a concise, easy-to-navigate document intended to reduce cognitive burden for ATI and to improve preparation. The new LA topicalization dosing tool serves as a patient weight-specific aid to ensure safe practice during topicalization for ATI. Both are attached to the ATI trolley.

Conclusions: Here we have outlined the development of a cognitive aid and dosing tool to improve safety during ATI at the Department of Anaesthesia of University Hospital Limerick. We anticipate that this quality improvement project could be rolled out to all departments of anaesthesia nationally as both a cognitive aid and a patient safety advancement.

Keywords: Airway; anaesthesia; intubation; safety; topicalization