Rapid sequence induction: An international survey

Jozef Klucka, Martina Kosinova, Kai Zacharowski, Stefan De Hert, Milan Kratochvil, Michaela Toukalkova, Roman Stoudek, Hana Zelinkova, Petr Stourac, Jozef Klucka, Martina Kosinova, Kai Zacharowski, Stefan De Hert, Milan Kratochvil, Michaela Toukalkova, Roman Stoudek, Hana Zelinkova, Petr Stourac

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.

Figures

Fig. 1
Fig. 1
Do you use Sellick manoeuvre in rapid sequence induction?
Fig. 2
Fig. 2
What kind of induction agent do you use for rapid sequence induction?
Fig. 3
Fig. 3
Do you ventilate the patient via face mask before anaesthesia induction (before first intubation attempt)?

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Source: PubMed

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