Simulation-based mastery of scalpel-bougie front-of-neck access among anesthesia providers: A prospective pre-post study

Background: Emergent surgical airway procedures, specifically scalpel-bougie front-of-the-neck access (SB-FONA), remain a critical yet rarely performed skill for anesthesia providers facing cannot intubate, cannot oxygenate clinical situations.Due to its rare occurrence, anesthesia providers report low confidence and limited experience in performing emergency surgical airways.Simulation-based training may maintain provider competency and confidence for this life-saving skill.Methods: Nurse anesthetists and anesthesiologists within a large academic health system completed preworkshop didactic materials and surveys assessing confidence and prior experience.Each participant performed a baseline SB-FONA attempt, received individualized instruction, and completed a post-training attempt.Performance was evaluated using a 15-point validated checklist, airway acquisition time, and tracheal insert damage.Confidence was measured on a five-point Likert scale.Results: Checklist scores and confidence improved significantly post-training ( p < .001)while procedural times decreased ( p < .001).Although overall tracheal insert damage did not change ( p = .79),damage location shifted significantly ( p = .008),indicating more accurate cricothyroid membrane targeting.Interrater reliability was high ( = 0.488-1.00,p < .001). Conclusions:The SB-FONA workshop significantly improved immediate provider confidence, technical accuracy, and efficiency, supporting regular simulation integration into anesthesia continuing education.