Assessment of anesthesiologists' rapid sequence induction technique in an university hospital

Abstract

Background and objectives: The induction of the general anesthesia in patients on "a full stomach" can result in regurgitation of the gastric content and pulmonary aspiration. The function of the rapid sequence induction (RSI) is to minimize the time interval between the loss of the airway protection reflexes and tracheal intubation tube balloon. The objective of this study was to evaluate the rapid sequence induction among the anesthesiologists of the São Paulo Hospital.

Methods: The participants answered the questionnaire voluntarily and anonymously, after signed consent. The questionnaire consisted of 60 questions about the fundamental points of the RSI. The questions were divided in pre-oxygenation, circuits, drugs used in the induction (opioids, hypnotics, neuromuscular blockers), cricoid pressure techniques, intubation and difficult intubation.

Results: Seventy-five questionnaires were applied and 22 were discarded due to incomplete answering. All anesthesiologists always declare doing pre-oxygenation and administering opioid, hypnotic, and neuromuscular blocker. Most use fentanyl (83%), propofol (74.5%) and succinylcoline (68.6%). All anesthesiologists apply cricoid pressure. Most did not know the correct pressure to be applied on the cricoid cartilage. Intubation failures have already occurred with 71.7% of anesthesiologists and with 40%, the regurgitation. When faced with an unexpected difficult intubation, anesthesiologists ask for the laryngeal mask (35.5%).

Conclusions: This study showed a broad individual variety of the RSI technique, a fact already reported by different authors. The difficulty in establishing a RSI protocol can be attributed to constant evidence that science provides us, where updating over the years becomes good medical practice.

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