Rapid sequence induction (RSI) in trauma patients: Insights from healthcare providers

Abstract

BACKGROUND: We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction (RSI) among trauma patients. METHODS: A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating specialties. RESULTS: A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol (74.5%) and Etomidate (50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients (P=0.001). Emergency physicians preferred Etomidate (63.6%) and Ketamine (20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium (55.6% vs. 27.7%, P=0.01) in stable as well as unstable (43.4 % vs. 27.7%, P=0.08) patients. CONCLUSION: There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.

Intubación rápida en pacientes críticos COVID-19 en Guayaquil Ecuador, 2020

“…Exiten muchos farmacos que se pueden usar en ISR, en esta técnica se administran ordenadamente anestesia, seguida de sedación y bloqueo neuromuscular. Para Wahlen et al, (2019), Andrezza Serpa et al, (2020) y Zuo et al, (2020) es deseable que dichos fármacos tengan un inicio y una duración de acción rápida, como ejemplo para la premedicación los fármacos recomendados de inicio son Lidocaína sin vasoconstrictor al 2% (1,5 mg / kg) y fentanilo (2 a 3 mcg / kg), debe tomarse en promedio 3 minutos antes de la inducción. En concordancia a lo anterior, la AMIB, (2020) emite la recomendación de amplio uso de estas drogas porque tienen como objetivo reducir la actividad simpática en la intubación, con la propiedad de abolir los reflejos laríngeos, reduciendo así la reactividad de la vía aérea.…”

Seguridad en la intubación de secuencia rápida recomendada en COVID-19: Informe de experiencia

“…Para IOT dos pacientes suspeitos ou confirmados para COVID-19, recomenda-se a Intubação de Sequência Rápida (ISR), que é uma técnica que consiste na administração de medicamentos, de acordo com uma sequência que inclui anestesia, seguida de sedação e bloqueio neuromuscular. É desejável que tais medicamentos tenham rápido início e duração de ação [6][7] .…”

Role of Etomidate in Critical Care for Rapid Sequence Intubation

“…Rapid sequence intubation is a process involving the administration of a sedative induction agent and a paralytic agent to facilitate endotracheal intubation. 1 This technique has been utilized by anesthesiologist and physicians in emergency situation at emergency department and intensive care units. RSI has become the standard goal for airway management in critical care.…”