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Join STARGATE Study
Multicenter international study on airway management for general anaesthesia in operating room and non-operating room procedures.
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* Indicates required question
Institution/Hospital name
*
Your answer
City
*
Your answer
Country
*
Your answer
Number of operating blocks in the institution (i.e. independent groups of operating rooms)
*
1
2
3
4
5
Other:
Estimated number of procedures under general anaesthesia performed per week in your hospital
*
10-30
30-50
50-70
70-100
100-150
>150
Other:
Estimated number of general anaesthesia in non-operating room anesthesia (NORA) performed per week
*
(e.g.
cardiac cath lab, invasive radiology, gastrointestinal endoscopy suite...)
<5
5-10
10-20
20-50
Other:
Principal investigator
Title
*
Dr.
Prof.
First name
*
Your answer
Last name
*
Your answer
Telephone number
*
Your answer
E-mail address
*
Your answer
Second contact person
First name
*
Your answer
Last name
*
Your answer
telephone number
*
Your answer
E-mail address
*
Your answer
I give my permission to publish my center name on the STARGATE study website (www.stargatestudy.com)
*
YES
NO
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