Background: Difficult airway management (DAM) presents a complex array of challenges inherent in establishing and maintaining a patient's airway during medical procedures or emergencies. Consequences of compromised DAM are profound, ranging from hypoxia, and aspiration, to cardiac arrest. Despite the ongoing progress and innovation in airway management, DAM remains a significant clinical challenge. Performing a bibliometric analysis of the most cited articles in this domain offers quantitative and qualitative insights into the landscape and trend of key research; our analysis revealed an increasing focus on video laryngoscopy research over the past decade, with a notable surge in studies related to airway management during infectious disease outbreaks in recent years.
Methods: We performed a bibliometric analysis of the 100 most-cited articles on DAM (Top100DAM) published between 2011 and 2022, sourced from both PubMed and Web of Science databases. Employing social network analysis, we identified key associated topics and cluster terms. Cluster terms are broad categories encompassing related topic terms. Topic terms are specific keywords or phrases found in the articles. Citation counts were estimated for each article, and cluster-specific reviews were generated using the Medical Query Expert software.
Results: The Top100DAM comprised 53 topic terms spanning 11 cluster terms. "Anesthesiology" stood out as the most frequently featured cluster, and "betacoronavirus" had the highest Impact Factor. There was a significant correlation between the counts between the inferred citation based on cluster terms and the observed citation (Pearson's R = 0.06, P = 0.02). To visualize, the network visualization and Sankey diagrams were used to illustrate the characteristics of the articles. The generated summary, utilizing natural language processing techniques, underscored the role of fiber-optic technology and video laryngoscopy in addressing DAM. During the COVID-19 pandemic, experts recommended the provision of supplemental oxygen and the prioritization of video laryngoscopy for anticipated DAM scenarios. Notably, the most cited articles predominantly concentrated on the importance of practice driven by guidelines and protocols for clinicians and anesthesiologists to manage difficult airways effectively.
Conclusion: DAM plays a central role in anesthesiology research, with a significant emphasis on guideline development, technological advancements like video laryngoscopy, and adapting practices for infectious disease scenarios. The increased publication volume and high citation rates during the COVID-19 pandemic underscore how ongoing research and innovation have accelerated, refining DAM practices. Articles with high citation rates mostly pertain to guidelines, illustrating their substantial impact on clinical practice and the necessity for studies to base their discussions on these guidelines. Future research should focus on addressing the implementation challenges of existing guidelines and developing context-specific protocols for diverse clinical settings.