Research Article

Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey

Volume: 5 Number: 1 August 29, 2026

Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey

Abstract

Objective: Awake tracheal intubation (ATI) is recommended for an anticipated difficult airway, yet its use remains limited. This study evaluated anesthesiologists’ ATI practices and scenario-based decision-making and identified factors associated with its use. Material and Methods: This cross-sectional, convenience-sampled online survey was conducted in Türkiye (13 March–13 April 2026). Anesthesiology residents and specialists completed an anonymous questionnaire covering demographics, three brief clinical scenarios (anticipated difficult airway, emergency, low cooperation), perceived barriers (a study-specific barrier score), and attitudes and practices. The primary outcome was self-reported performance of ATI at least once within the previous year; secondary outcomes were scenario-based decision-making, overall frequency, associated factors, and perceived barriers. Multivariable logistic regression explored associated factors (N = 302). Results: Among 302 respondents, 30.8% reported performing ATI at least once within the previous year, and only 3.0% did so frequently or very frequently. In the anticipated difficult airway scenario 70.2% selected ATI. In the emergency scenario 51.7% preferred ATI. In the low-cooperation scenario 10.6% expressed a definite preference. Response formats differed across scenarios, so these proportions are not directly comparable. Respondents reporting ATI practice had lower barrier scores. In multivariable analysis, greater clinical experience was associated with higher odds of ATI practice, whereas state-hospital employment and a higher barrier score were associated with lower odds. Conclusion: Self-reported ATI practice was limited and showed scenario-specific response patterns. Greater clinical experience, lower perceived barriers, and institutional setting were associated with reported practice and may inform future training and institutional strategies; the cross-sectional, convenience-sampled design precludes causal inference.

Keywords

Airway management, Anesthesiologists, Awake tracheal intubation, Decision making, Difficult airway

Supporting Institution

None

Ethical Statement

Ethical approval for this study was obtained from the Kocaeli City Hospital Scientific Research Ethics Committee (Approval No: 2026-33, Date: 12.03.2026). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki (1964) and its subsequent amendments, and with the relevant regulations of the Ministry of Health of the Republic of Türkiye. Electronic informed consent was obtained from all participants before they were able to access the questionnaire.

Thanks

None

References

  1. Ahmad, I., El-Boghdadly, K., Bhagrath, R., Hodzovic, I., McNarry, A. F., Mir, F., O’Sullivan, E. P., Patel, A., Stacey, M., & Vaughan, D. (2020). Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia, 75(4), 509–528. https://doi.org/10.1111/anae.14904
  2. Alhomary, M., Ramadan, E., Curran, E., & Walsh, S. R. (2018). Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: A systematic review and meta-analysis. Anaesthesia, 73(9), 1151–1161. https://doi.org/10.1111/anae.14299
  3. Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., Fiadjoe, J. E., Greif, R., Klock, P. A., Mercier, D., Myatra, S. N., O’Sullivan, E. P., Rosenblatt, W. H., Sorbello, M., & Tung, A. (2022). 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology, 136(1), 31–81. https://doi.org/10.1097/ALN.0000000000004002
  4. Boulton, A. J., Balla, S. R., Nowicka, A., Loka, T. M., & Mendonca, C. (2019). Advanced airway training in the UK: A national survey of senior anesthetic trainees. Journal of Anaesthesiology Clinical Pharmacology, 35(3), 326–334. https://doi.org/10.4103/joacp.JOACP_325_18
  5. Çalışır, F. (2023). Evaluation of the knowledge, skills and practices on rapid sequence intubation of physicians working in anesthesiology and reanimation clinics in Turkey: A survey study. Journal of Anesthesia and Reanimation Specialists Society, 31(4), 349–356. https://doi.org/10.54875/jarss.2023.72602
  6. Chen, F., Tan, Z., He, Q., & Li, Q. (2025). Guideline recommendations on the assessment and management of awake airway intubation: A systematic review. BMC Anesthesiology, 25(1), 79. https://doi.org/10.1186/s12871-025-02940-3
  7. Cook, T. M., Woodall, N., & Frerk, C. (2011). Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. British Journal of Anaesthesia, 106(5), 617–631. https://doi.org/10.1093/bja/aer058
  8. Downey, A., Oughton, C., Makar, T., Endlich, Y., Graham, J. M., Ellard, L., & Law, J. A. (2025). Awake tracheal intubation: A survey of practices, barriers and skills maintenance. Anaesthesia and Intensive Care. 54(3):250-257. Advance online publication. https://doi.org/10.1177/0310057X251397168
  9. El-Boghdadly, K., Onwochei, D. N., Cuddihy, J., & Ahmad, I. (2017). A prospective cohort study of awake fibreoptic intubation practice at a tertiary centre. Anaesthesia, 72(6), 694–703. https://doi.org/10.1111/anae.13844
  10. Eysenbach, G. (2004). Improving the quality of web surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Journal of Medical Internet Research, 6(3), e34. https://doi.org/10.2196/jmir.6.3.e34
APA
Çetin, E., & Yuksek, A. (2026). Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey. Farabi Medical Journal, 5(1). https://doi.org/10.59518/farabimedj.1976321
AMA
1.Çetin E, Yuksek A. Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey. Farabi Medical Journal. 2026;5(1). doi:10.59518/farabimedj.1976321
Chicago
Çetin, Engin, and Ahmet Yuksek. 2026. “Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey”. Farabi Medical Journal 5 (1). https://doi.org/10.59518/farabimedj.1976321.
EndNote
Çetin E, Yuksek A (August 1, 2026) Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey. Farabi Medical Journal 5 1
IEEE
[1]E. Çetin and A. Yuksek, “Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey”, Farabi Medical Journal, vol. 5, no. 1, Aug. 2026, doi: 10.59518/farabimedj.1976321.
ISNAD
Çetin, Engin - Yuksek, Ahmet. “Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey”. Farabi Medical Journal 5/1 (August 1, 2026). https://doi.org/10.59518/farabimedj.1976321.
JAMA
1.Çetin E, Yuksek A. Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey. Farabi Medical Journal. 2026;5. doi:10.59518/farabimedj.1976321.
MLA
Çetin, Engin, and Ahmet Yuksek. “Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey”. Farabi Medical Journal, vol. 5, no. 1, Aug. 2026, doi:10.59518/farabimedj.1976321.
Vancouver
1.Engin Çetin, Ahmet Yuksek. Awake Tracheal Intubation Practice and Clinical Decision-Making in Brief Airway Scenarios Among Anesthesiologists in Türkiye: A Cross-Sectional Survey. Farabi Medical Journal. 2026 Aug. 1;5(1). doi:10.59518/farabimedj.1976321