A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury

Parida, Satyen; Varadharajan, Ramesh; Bidkar, Prasanna Udupi; Mishra, Sandeep Kumar; Balachander, Hemavathi; Badhe, Ashok Shankar; Kundra, Pankaj

doi:10.4103/0019-5049.179463

Cited by 2 publications

(5 citation statements)

References 12 publications

(12 reference statements)

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“…High variability in the modalities of rapid sequence intubation has been reported in national surveys and randomized clinical trials published between 2015 and 2020 . Rapid sequence intubation without neuromuscular blockers was performed in 25% to 75% of patients at risk of aspiration .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 High variability in the modalities of rapid sequence intubation has been reported in national surveys and randomized clinical trials published between 2015 and 2020. [4][5][6][7][8] Rapid sequence intubation without neuromuscular blockers was performed in 25% to 75% of patients at risk of aspiration. [4][5][6][7][8] This observation is possibly explained by concerns about potential severe adverse effects of neuromuscular blockers, including anaphylaxis, 9 prolonged curarisation, 10 metabolic disturbance, 11 and postoperative respiratory complications.…”

mentioning

confidence: 99%

“…[4][5][6][7][8] Rapid sequence intubation without neuromuscular blockers was performed in 25% to 75% of patients at risk of aspiration. [4][5][6][7][8] This observation is possibly explained by concerns about potential severe adverse effects of neuromuscular blockers, including anaphylaxis, 9 prolonged curarisation, 10 metabolic disturbance, 11 and postoperative respiratory complications. 12 However, even if rapid sequence intubation without neuromuscular blockers is frequently performed in clinical practice, its noninferiority has not been demonstrated yet.…”

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confidence: 99%

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Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration

Grillot

Lebuffe

Huet

et al. 2023

JAMA

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ImportanceIt is uncertain whether a rapid-onset opioid is noninferior to a rapid-onset neuromuscular blocker during rapid sequence intubation when used in conjunction with a hypnotic agent.ObjectiveTo determine whether remifentanil is noninferior to rapid-onset neuromuscular blockers for rapid sequence intubation.Design, Setting, and ParticipantsMulticenter, randomized, open-label, noninferiority trial among 1150 adults at risk of aspiration (fasting for &lt;6 hours, bowel occlusion, recent trauma, or severe gastroesophageal reflux) who underwent tracheal intubation in the operating room at 15 hospitals in France from October 2019 to April 2021. Follow-up was completed on May 15, 2021.InterventionsPatients were randomized to receive neuromuscular blockers (1 mg/kg of succinylcholine or rocuronium; n = 575) or remifentanil (3 to 4 μg/kg; n = 575) immediately after injection of a hypnotic.Main Outcomes and MeasuresThe primary outcome was assessed in all randomized patients (as-randomized population) and in all eligible patients who received assigned treatment (per-protocol population). The primary outcome was successful tracheal intubation on the first attempt without major complications, defined as lung aspiration of digestive content, oxygen desaturation, major hemodynamic instability, sustained arrhythmia, cardiac arrest, and severe anaphylactic reaction. The prespecified noninferiority margin was 7.0%.ResultsAmong 1150 randomized patients (mean age, 50.7 [SD, 17.4] years; 573 [50%] women), 1130 (98.3%) completed the trial. In the as-randomized population, tracheal intubation on the first attempt without major complications occurred in 374 of 575 patients (66.1%) in the remifentanil group and 408 of 575 (71.6%) in the neuromuscular blocker group (between-group difference adjusted for randomization strata and center, –6.1%; 95% CI, –11.6% to –0.5%; P = .37 for noninferiority), demonstrating inferiority. In the per-protocol population, 374 of 565 patients (66.2%) in the remifentanil group and 403 of 565 (71.3%) in the neuromuscular blocker group had successful intubation without major complications (adjusted difference, –5.7%; 2-sided 95% CI, –11.3% to –0.1%; P = .32 for noninferiority). An adverse event of hemodynamic instability was recorded in 19 of 575 patients (3.3%) with remifentanil and 3 of 575 (0.5%) with neuromuscular blockers (adjusted difference, 2.8%; 95% CI, 1.2%-4.4%).Conclusions and RelevanceAmong adults at risk of aspiration during rapid sequence intubation in the operating room, remifentanil, compared with neuromuscular blockers, did not meet the criterion for noninferiority with regard to successful intubation on first attempt without major complications. Although remifentanil was statistically inferior to neuromuscular blockers, the wide confidence interval around the effect estimate remains compatible with noninferiority and limits conclusions about the clinical relevance of the difference.Trial RegistrationClinicalTrials.gov Identifier: NCT03960801

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration

Grillot

Lebuffe

Huet

et al. 2023

JAMA

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“…A recent study from India for RSI in patients with head injury revealed the predominant use of rocuronium over suxamethonium. [9] However, the ratio was less impressive as compared to the other study from Germany. [17] In the Indian study, most of the anaesthetists used rocuronium (44%), followed by suxamethonium (39%).…”

Section: Discussionmentioning

confidence: 69%

“…The current literature suggest that the existing diversity regarding choice of drugs for RSI might be at least country specific. [8,9] Therefore, the aim of the present study is to describe the current practice of emergency physicians and anaesthesiologists with respect to the selection of drugs for RSI in trauma patients in a single institute with a level I trauma centre.…”

Section: Introductionmentioning

confidence: 99%

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

Wahlen

El‐Menyar

Asim

et al. 2019

World Journal of Emergency Medicine

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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.

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A survey of a population of anaesthesiologists from South India regarding practices for rapid sequence intubation in patients with head injury

Cited by 2 publications

References 12 publications

Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration

Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration

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

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