Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844760
Brazilian Journal of Anesthesiology
Original Investigation

Use, perceptions, and barriers to supraglottic airway devices in Brazil: a national cross-sectional survey with global implications

Uso, percepções e barreiras aos dispositivos supraglóticos de vias aéreas no Brasil: um estudo transversal nacional com implicações globais

Jayme M. dos Santos Neto, Flávia J. de Barros, Victor M. Lemos, Clístenes Crístian de Carvalho

http://dx.doi.org/10.1016/j.bjane.2026.844760 Braz J Anesthesiol, vol.76, n4, p.0, 2026
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Abstract

Background

Supraglottic Airway Devices (SADs) are essential in airway management. However, little is known about their use, perceptions, and barriers in large, resource-variable healthcare systems such as Brazil. We aimed to assess current practice patterns, training exposure, and barriers to SADs use among Brazilian anesthesiologists and trainees.

Methods

A nationwide, web-based survey that addressed demographics, training exposure, device availability, frequency of use, perceived safety and efficacy, barriers to use, and knowledge of SADs generations. Descriptive and inferential statistics were used to analyze regional and experiential patterns.

Results

A total of 432 completed responses were analyzed. Most respondents were fully trained anesthesiologists (75.5%) from all five Brazilian regions. Although SADs were widely perceived as safe (76.9%) and capable of providing adequate ventilation (74.3%), only 35% reported using them at least once per week, and fewer than 20% felt confident distinguishing between first and second-generation devices. Binomial logistic regression revealed that greater training exposure during residency was strongly associated with more frequent current use (OR = 7.3; 95% CI 3.8‒14.3, p < 0.001). The most common barrier was lack of operator experience (81.5%), followed by limited availability of devices (28.9%). Use varied across regions (p  < 0.001), with 82% of anesthesiologists in the South reporting weekly use compared to only 15.4% in the North. Respondents were more likely to use SADs in limb surgeries, while use is limited in gastrointestinal and thoracic procedures.

Conclusions

Despite favorable perceptions of safety and efficacy, SADs remain underused in Brazil, with marked regional variation and limited familiarity with device generations. Training exposure emerged as a strong predictor of current use, underscoring the importance of structured education and hands-on experience. Addressing gaps in training and improving device availability may help standardize practice and enhance the use of SADs across the country.
 
Institutional Research Board approval n° 7.214.701; CAAE: 84060624.6.0000.8807.

Keywords

Airway management; Anesthesiology; Continuing medical education; Laryngeal masks; Patient safety; Surveys and questionnaires

Resumo

Introdução

Os dispositivos supraglóticos de vias aéreas (DSAs) são essenciais no manejo das vias aéreas. No entanto, pouco se sabe sobre seu uso, percepções e barreiras em sistemas de saúde grandes e com recursos variáveis, como o Brasil. Nosso objetivo foi avaliar os padrões de prática atuais, a exposição ao treinamento e as barreiras ao uso de DSAs entre anestesiologistas e formandos brasileiros.

Métodos

Um inquérito nacional baseado na web que abordou dados demográficos, exposição ao treinamento, disponibilidade de dispositivos, frequência de uso, percepção de segurança e eficácia, barreiras ao uso e conhecimento das gerações de DSAs. Estatísticas descritivas e inferenciais foram usadas para analisar padrões regionais e de experiência.

Resultados

Foram analisadas 432 respostas completas. A maioria dos respondentes era composta por anestesiologistas com formação completa (75,5%) de todas as cinco regiões brasileiras. Embora os DSAs tenham sido amplamente percebidos como seguros (76,9%) e capazes de fornecer ventilação adequada (74,3%), apenas 35% relataram usá-los pelo menos uma vez por semana, e menos de 20% sentiram-se confiantes em distinguir entre dispositivos de primeira e segunda geração. A regressão logística binomial revelou que uma maior exposição ao treinamento durante a residência estava fortemente associada a um uso atual mais frequente (OR = 7,3; IC 95% 3,8–14,3, p < 0,001). A barreira mais comum foi a falta de experiência do operador (81,5%), seguida pela disponibilidade limitada de dispositivos (28,9%). O uso variou entre as regiões (p < 0,001), com 82% dos anestesiologistas no Sul relatando uso semanal em comparação com apenas 15,4% no Norte. Os respondentes foram mais propensos a usar DSAs em cirurgias de extremidades, enquanto o uso é limitado em procedimentos gastrointestinais e torácicos.

Conclusões

Apesar das percepções favoráveis de segurança e eficácia, os DSAs continuam sendo subutilizados no Brasil, com marcante variação regional e familiaridade limitada com as gerações dos dispositivos. A exposição ao treinamento surgiu como um forte preditor do uso atual, ressaltando a importância da educação estruturada e da experiência prática. Abordar as lacunas no treinamento e melhorar a disponibilidade de dispositivos pode ajudar a padronizar a prática e aumentar o uso de DSAs em todo o país.
 
Aprovação do Institutional Research Board n° 7.214.701; CAAE: 84060624.6.0000.8807.

Palavras-chave

Manejo das vias aéreas; Anestesiologia; Educação médica continuada; Máscaras laríngeas; Segurança do paciente; Inquéritos e questionários

Referencias

1. Cook TM, Ogelsby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia. 2023;79(4).

2. Van Zundert AAJ, Gatt SP, Van Zundert TCRV, Hagberg CA, Pandit JJ. Supraglottic Airway Devices: Present State and Outlook for 2050. Anesth Analg. 2024;138:337−49.

3. Cook TM, Kelly FE. Time to abandon the “vintage” laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. British Journal of Anaesthesia. 2015;115:497−9.

4. de Carvalho CC, Kapsokalyvas I, El-Boghdadly K. Second-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis. Anesth Analg. 2025;140:265−75.

5. Hummel R, Wollschlager D, Baldering Hans-Jürgen, Engelhard K, Wittenmeier E, Epp K, et al. Big data: Airway management at a university hospital over 16 years; a retrospective analysis. PloS One. 2022;17:e0273549.

6. Werner J, Klementova O, Bruthans J, Macoun J, Gaszynski T, Henlin T, et al. Evaluation of the i-gel® Plus supraglottic airway device in elective surgery: a prospective international multicentre study. Anaesthesia. 2024;79:1284−91.

7. Obeidat SS, Suleiman A, Ahrens E, Needham MJ, Stewart C, Khany M, et al. Real-World Evaluation of i-gel Introduction on Intraoperative Airway-Related Safety Events: A Retrospective Cohort Study from a New England Hospital Network. Anesth Analg. 2025;140:253−61.

8. Scheffer M. DemografiaMedica no Brasil 2025. 1o ed Brasília, DF: Ministerio da Saúde; 2025. [Internet][cited 2026 Apr 4]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/%20demografia_medica_brasil_2025.pdf.

9. Toy S, Daly Guris RJ. How to conduct survey-based research. Anaesthesia. 2023;78:902−5.

10. Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36:3179−87.

11. Story D, Tait A. Readers’ toolbox Understanding Research Methods. Anesthesiology. 2019;130:192−202.

12. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) ‒ a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42: 377−81.

13. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Informatics. 2019;95:103208.

14. Hugo A, Gutierrez A, Hugo M, Gutierrez A. Package ‘samplesize4surveys. 2022. [Internet][cited 2026 Apr 6]. Available from:https://cran.r-project.org/web/packages/samplesize4surveys/samplesize4surveys.pdf.

15. Yang LQ, Zhu L, Shi X, Miao CH, Yuan HB, Liu ZQ, et al. Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation. Anaesthesia. 2023;78:953−62.

16. Forestell B, Ramsden S, Sharif S, Centofanti J, Al Lawati K, Fernando SM, et al. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med. 2024;52:E89−99.

17. Ullmann H, Renziehausen L, Geil D, Sponholz C, ThomasRuddel D, Völker MT, et al. The Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial. Anesth Analg. 2022;135 (4):769−76.

18. Hammer M, Santer P, Schaefer MS, Althoff FC, Wongtangman K, Frey UH, et al. Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study. Br J Anaesth. 2021;126:738−45.

19. Yan C, Zhang Y, Chen Y, Qv Z, Zuo M. Comparison of SaCoVLMTM video laryngeal mask-guided intubation and i-gel combined with flexible bronchoscopy-guided intubation in airway management during general anesthesia: a non-inferiority study. BMC Anesthesiol. 2022;22:302.

20. Govardhane BT, Shinde AD, Gehdoo RP, Arora S. Current practice pattern among anaesthesiologists for difficult airway management: A nationwide cross-sectional survey. Indian J Anaesth. 2023;67:809−14.

21. Krug N, Thieme V, Voelker MT, Bercker S. Results of an international survey on the use and perceptions of the laryngeal mask airway (LMA). Luong CQ, editor. PLOS One. 2025;20: e0321421.

22. He Y, Zhang Z, Li R, et al. National survey on the current status of airway management in China. Sci Rep. 2024;14:15627.

23. Goodwin L, Samuel K, Schofield B, et al. Airway management during in-hospital cardiac arrest in adults: UK national survey and interview study with anaesthetic and intensive care trainees. J Intensive Care Soc. 2021;22:192−7.

Submitted date:
11/09/2025

Accepted date:
09/04/2026

6a6223d4a953953f477f8ef7 rba Articles
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