The purpose of this interdisciplinary pilot study developed by physical therapy and nursing faculty and students was to evaluate the education, awareness, and confidence of anesthesia providers to evaluate TMJ in patients undergoing non-emergency orotracheal intubation.
An online questionnaire was created using Qualtrics® online survey software (Qualtrics Labs Inc, Provo, Utah). The survey included 21 questions related to demographics, work experience, self-perceived knowledge and adequacy of entry-level education, awareness of TMJ risks, and current confidence levels on evaluating TMJ. Descriptive statistics and cross-tabulation analysis were performed.
A total of 36 anesthesia providers participated (mean 47 years-old ±12; 73% female). All participants were Certified Registered Nurse anesthetist (CRNA). Over half (55%) reported never taking any classes on TMJ related to orotracheal intubation including anatomy/biomechanics, evaluation, and/or risks of intubation to TMJ during their education. A total of 89% (26) reported to somewhat or very little received adequate information/education on the management of TMJ issues related to intubation during their entry-level education. Twenty-one percent reported not aware of alternative equipment/techniques to use for non-emergency intubation based on the TMJ status. Less than half (44%) reported to always or very often evaluate TMJ status including any presence of pain, and a total of 72% do not evaluate TMJ status post-intubation. Thirty-eight percent reported yes to feeling confident evaluating TMJ. From those not confident, only 28% consult of refer the patient to another provider. After the survey, all participants felt more aware about the importance of proper education on and the TMJ evaluation before and after non-emergency orotracheal intubation.
The most majority of the anesthesia providers did not receive adequate information/education on the management of TMJ issues related to intubation during their entry-level education and most think it would be important to have more content on TMJ evaluation and management when learning about orotracheal intubation during their entry level education. Only 38% reported confident evaluating TMJ when conducting non-emergency intubation.
The preliminary results show that more education on TMJ evaluation related to intubation during entry-level education is needed in anesthesia nursing programs. This survey helped to increase the awareness of anesthesia providers regarding the importance of evaluating TMJ when conducting intubation. This increase of awareness may contribute to reducing TMJ issues associated with non-emergency intubations. It may also increase collaborations between physiotherapists and nurse anesthetists in the management of patients with TMJ issues after intubation since physiotherapy is considered one of the most effective conservative treatments for temporomandibular disorders. More research involving physiotherapists, dentists, and anesthesia providers to evaluate and prevent TMJ issues with intubation is needed. Future studies should include larger sample and include anesthesiologists to increase generalizability of the study.
Intubation
interdisciplinary
