Evidence based use of modified rapid sequence induction at a low income country: A systematic review

Abstract

Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. A modification of this technique is implemented in certain clinical circumstances. Search engines like Pub Med through HINARI, Cochrane database, Google Scholar to get access for current and updated evidences on modified RSII. This guideline provides a strategy to manage and reduce complications of anesthesia in patients who are easily suspectable for desaturation. Senior anaesthetists’, with input from department of surgery, were responsible to develop this clinical guideline to promote the best evidence-based, effective, affordable, and safer management of the indicated patients with modified RSII. As part of the guideline development process, a systematic review of studies published in peer-review journals were employed on varies aspects related to treatment, assessment and risk stratification. After a comprehensive searching of electronic sources and a review of the evidence, the authors formulated recommendations that addressed various aspects of optimization of patients, considering setups with limited recourse. Highlights:

Successfully anticipated difficult airway management of a “can ventilate, but cannot intubate” situation for urgent laparoscopic appendectomy in a patient with Duchenne muscular dystrophy

“…The selection of a modi ed Rapid Sequence Induction (RSI) approach in the context of a potentially challenging airway (12), utilizing short-acting Remifentanil (7) and Rocuronium, with the option of reversal using Sugammadex (6), aligns with established practices documented in the literature. Notably, Succinylcholine is contraindicated in individuals with Duchenne muscular dystrophy (13) due to the associated risks.…”

Successfully Anticipated Difficult Airway Management of a “Can Ventilate, but Cannot Intubate” Situation for Urgent Laparoscopic Appendectomy in a Patient with Duchenne Muscular Dystrophy

“…The selection of a modified Rapid Sequence Induction (RSI) approach in the context of a potentially challenging airway [16], utilizing short-acting Remifentanil [11] and Rocuronium, with the option of reversal using Sugammadex [10], aligns with established practices documented in the literature. Notably, Succinylcholine is contraindicated in individuals with Duchenne muscular dystrophy [2] due to the associated risks.…”

Secuencia rápida de inducción e intubación: una revisión narrativa

“…El evento predominante fue la inestabilidad cardiovascular, observada en el 42,6 % de todos los pacientes sometidos a intubación de urgencia, seguido de hipoxemia grave (9,3 %) y paro cardiaco (3,1 %) (12). Se ha reportado taquicardia en el 32,7 % y bradicardia en 5,2 % de los pacientes (13). Se ha encontrado, además, un porcentaje de éxito al primer intento de intubación de solo el 84,1 % (IC 95 % 80,1 -87,4), intubación esofágica en el 3,5 %, requerimiento de tres o más intentos de intubación en el 0,8 % y necesidad de cricotiroidotomía en 0,3 % de los pacientes (14).…”