Rapid sequence induction

Abstract

BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03694860

Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

“…Therefore, if the anesthesia is induced in high head position and regurgitation still occurs, the possibility of aspiration may be higher. Therefore, when faced with patients with high risk of reflux aspiration, some anesthesiologists tend to use head-down induction[ 13 ]. The technique of cricoid pressure was first proposed by Sellick in 1961 and can largely prevent reflux of gastroesophageal contents[ 14 ].…”

Anesthesia for Reconstructive Surgery of Head and Neck.

“…This pressure increase would prevent the regurgitation of food debris that could be found in the stomach after anesthetic induction of the patient. To date, it is quite questioned and more than half of anesthesiologists do not use it [8]. Another useful maneuver during airway management, which requires manipulation of the thyroid cartilage, is the "BURP maneuver [9].…”

Pre‐operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study

“…and clinical grading of various other conditions and procedures associated with an increased risk remains a challenge [6]. Furthermore, rapid sequence induction of anaesthesia as standard practice for emergency surgery in non-fasted patients or those at increased risk of aspiration carries the risk of haemodynamic instability and rapid desaturation where tracheal intubation and rescue mask ventilation fail [7,8], and there is no convincing evidence that it reduces the incidence of pulmonary aspiration [9].…”

“…For example, thorough patient history and clinical examination may reveal obvious risk factors such as gastrointestinal obstruction [2], and clinical grading of various other conditions and procedures associated with an increased risk remains a challenge [6]. Furthermore, rapid sequence induction of anaesthesia as standard practice for emergency surgery in non‐fasted patients or those at increased risk of aspiration carries the risk of haemodynamic instability and rapid desaturation where tracheal intubation and rescue mask ventilation fail [7, 8], and there is no convincing evidence that it reduces the incidence of pulmonary aspiration [9]. Finally, defined minimal durations of pre‐operative fasting are considered standard practice for patients undergoing elective surgery [10, 11], even though prolonged fasting can lead to negative psychological, physiological and metabolic responses to surgery [11, 12].…”