• A K Nørskov, J Wetterslev, C V Rosenstock, A Afshari, G Astrup, J C Jakobsen, J L Thomsen, M Bøttger, M Ellekvist, B M B Schousboe, A Horn, B G Jørgensen, K Lorentzen, M H Madsen, J S Knudsen, B K Thisted, S Estrup, H B Mieritz, T Klesse, H J Martinussen, A G Vedel, R Maaløe, K B Bøsling, P R C Kirkegaard, C R Ibáñez, G Aleksandraviciute, L S Hansen, T Mantoni, and L H Lundstrøm.
• Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark anderskehlet@hotmail.com.
• Br J Anaesth. 2016 May 1; 116 (5): 680-9.

BackgroundUnanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.MethodsFrom 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.ResultsA total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).ConclusionsUsing the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.Clinical Trial RegistrationNCT01718561.© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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