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

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.