'Tea trolley' difficult airway teaching 2022: A new spin on an old idea.

Awake tracheal intubation (ATI) remains an important skill for the management of complex or threatened airways. However, anaesthetists indicate that we are less confident with this technique than any other airway management skill. 1 These days, it also appears that ATI is less commonly performed. 2 Australian and New Zealand College of Anaesthetists’ training currently requires trainees to be present or perform five awake bronchoscopies or intubations. 3 Experts believe more hands-on time is required for proficiency. Marsland et al. described that the development of basic bronchoscopic psychomotor skills on a bench-top trainer required multiple episodes of training, each lasting 20–30 minutes and totalling two to four hours. 4 Moreover, handling of a bronchoscope is only one aspect of awake bronchoscopic intubation. Safe and well-tolerated passage of an endotracheal tube also requires experience with topicalisation, ergonomics, troubleshooting technical issues and sedation (if provided). To our knowledge, there are no data guiding how many awake intubations are required to gain competence across all these skills. While five episodes with ideal conditions are achievable during training years, they are unlikely to convert a novice to a confident practitioner, let alone an expert. A review