Rapid sequence induction: a national survey of practice

Abstract

We performed a national postal survey exploring anaesthetists' practice in rapid sequence induction. All respondents used pre-oxygenation, although the technique employed, and its reliability, varied. Thiopental and succinylcholine, given after waiting for signs of loss of consciousness, were the most widely used drugs for rapid sequence induction. Propofol and rocuronium were used by more than a third of respondents, and most respondents (75%) also routinely administered an opioid. Cricoid pressure was used universally but the practice of its application varied widely. The commonest aids used if intubation was difficult were the gum elastic bougie, the long laryngoscope blade and the laryngeal mask. After failed intubation, approximately half of respondents would maintain the supine position. Failure to intubate at rapid sequence intubation had been seen by 45% of respondents but harm was uncommon. In contrast, 28% had seen regurgitation, which frequently led to considerable harm and to three deaths. In spite of this, practice of a failed intubation drill was uncommon (15%) and anaesthetic assistants were rarely known to practice application of cricoid pressure. Consultants were less likely than trainees to use rocuronium as a muscle relaxant, and more likely to choose morphine if administering an opioid. They were less likely to practice a failed intubation drill. Other aspects of practice varied little between grades. This survey suggests that many anaesthetists do not follow best practice when performing a rapid sequence induction.

Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

“…O rocurônio é um agente não-despolarizante que, quando administrado em doses de 0,9 a 1,2 mg.kg -1 , pode promover condições adequadas para intubação em 60 segundos. Escolheu-se o rocurônio por ser um agente capaz de substituir a succinilcolina em indução de seqüência rápida, sem alterar a pressão intracraniana 11,12 . O conceito de dose prime de bloqueador neuromuscular consiste na administração de 10% da dose de intubação deste, cerca de 2 a 4 minutos antes de se administrar o restante, para que se obtenha condições de intubação em um menor tempo, geralmente, reduzido em 30 a 60 segundos do tempo normal, variando para cada droga.…”

“…Rocuronium is an non-depolarizing agent which, in doses of 0.9 to 1.2 mg.kg -1 , may promote adequate intubation conditions in 60 seconds. Rocuronium was chosen because it may replace succinylcholine during rapid sequence induction without changing intracranial pressure 11,12 . Neuromuscular blocker priming dose consists in the administration of 10% of its intubation dose approximately 2 to 4 minutes before administering the remaining dose, to obtain tracheal intubation conditions in a shorter time, in general 30 to 60 seconds less than normal time, depending on the drug.…”

Compressão da cartilagem cricóide: aspectos atuais

“…As respostas variaram de 1 a 44N para pacientes conscientes e de 2 a 80N para os inconscientes. Muitos não sabiam a força indicada ou a descrevia como "suficiente", "força para quebrar um ovo" ou "varia" 29 . Por outro lado, em estudo sobre a aplicação da manobra de Sellick em crianças, apenas 59% dos anestesiologistas entrevistados afirmaram empregar a técnica.…”

Gambling with ethics? A statistical note on the Poisson (binomial) distribution

“…The anaesthetic management of emergency appendicectomy in the UK normally involves a 'rapid sequence' induction which includes a period of pre-oxygenation, application of cricoid pressure and prompt tracheal intubation (usually before any manual ventilation of the lungs and facilitated by a rapidly-acting muscle relaxant such as suxamethomium). The technique has the weight of 'historical authority' (and also has its critics [13,14]) and the logic supporting it is that all components are (i) designed to minimise risk of aspiration (regardless of whether they actually do so or not) and (ii) enable a rapid rescue strategy should tracheal intubation fail. Apart from pre-oxygenation, Fabregat-López et al apparently abandoned all these components.…”