Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation

Thwaites, Alison J.; Rice, Ciara; Smith, Ian

doi:10.1046/j.1365-2044.1999.00738.x

Cited by 70 publications

(47 citation statements)

References 29 publications

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“…For Caesarean section, 85% of respondents used thiopental compared with 96% in the 1996 survey by Thwaites, published in 1999 [19]. There have been several studies comparing propofol to thiopental for induction of anaesthesia for elective Caesarean section [20][21][22][23][24][25][26][27][28][29][30].…”

Section: Resultsmentioning

confidence: 99%

Variation in rapid sequence induction techniques: current practice in Wales

et al. 2008

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SummaryA questionnaire survey examining rapid sequence induction techniques was sent to all anaesthetists in Wales. The questionnaire presented five common clinical scenarios: emergency appendicectomy; elective knee arthroscopy with a symptomatic hiatus hernia; elective knee arthroscopy with an asymptomatic hiatus hernia; elective Caesarean section; and emergency laparotomy for bowel obstruction. Completed surveys were received from 421 anaesthetists, a 68% response rate. Rapid sequence induction was chosen by 398 ⁄ 400 respondents (100%) for bowel obstruction, 392 ⁄ 399 (98%) for Caesarean section, 388 ⁄ 408 (95%) for appendicectomy, 328 ⁄ 395 (83%) for symptomatic hiatus hernia but only 98 ⁄ 399 (25%) for asymptomatic hiatus hernia (p < 0.001). Trainees were more likely to use a rapid sequence induction technique than consultants and staff grades for the appendicectomy (p = 0.025), symptomatic hiatus hernia (p = 0.004) and asymptomatic hiatus hernia (p = 0.001) scenarios and were also more likely to use a thiopental-suxamethonium combination for rapid sequence induction (p < 0.001).

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Section: Resultsmentioning

confidence: 99%

Variation in rapid sequence induction techniques: current practice in Wales

et al. 2008

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“…Cricoid pressure is used almost universally in the UK during general anaesthesia for caesarean section [78], although practice varies in other countries [79]. Current evidence supports applying 10 N force initially and then increasing to 30 N after loss of consciousness [80], as too much force (e.g.…”

Section: Rapid Sequence Inductionmentioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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“…Bei kranken Erwachsenen und kleinen Kindern kommt es bereits inner halb weniger als 60 s nach Einleitung, d. h. noch vor Beginn der direkten Laryngo skopie und endotrachealen Intubation zur Hypoxämie. Auch in der Erwachse nenanästhesie wird dieses überstürzte, un kontrollierte Vorgehen bei der klassischen Ileusintubation wegen der damit verbun denen Komplikationen, insbesondere der durch die Hektik bedingten erhöhten In zidenz von schwierigen Intubationen, zu nehmend infrage gestellt [15,50].…”

Section: Rsi-intubation Beim Erwachsenenunclassified

Anästhesieeinleitung und Intubation beim Kind mit vollem Magen

Weiß

Gerber

2007

Anaesthesist

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Classical adult type rapid sequence induction (RSI) intubation is not always appropriate in children. In newborns, infants and small children, limited cooperation during pre-oxygenation, reduced respiratory oxygen reserves, increased oxygen demand and a tendency for airway collapse, easily lead to hypoxaemia after induction of anaesthesia. Gentle mask ventilation with pressures not exceeding 10-12 degrees cm H(2)O allows oxygenation without the risk of gastric inflation and aspiration. Risk factors leading to pulmonary aspiration are bucking, coughing and straining during induction or tracheal intubation and active regurgitation and vomiting during laryngoscopy under light anaesthesia and incomplete muscle paralysis. Gentle mask ventilation allows tracheal intubation under optimised oxygenation, haemodynamics, depth of anaesthesia and complete muscle relaxation. Application of cricoid pressure does not reliably prevent pulmonary aspiration. In children cricoid pressure clearly interferes with smooth induction of anaesthesia, results in difficult mask ventilation and intubation as well as provokes bucking and straining and, therefore, should not be routinely used. Key features of RSI intubation for children are effective induction of deep anaesthesia followed by profound muscle paralysis, careful mask ventilation and gentle tracheal intubation under optimised conditions.

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Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation

Cited by 70 publications

References 29 publications

Variation in rapid sequence induction techniques: current practice in Wales

Variation in rapid sequence induction techniques: current practice in Wales

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Anästhesieeinleitung und Intubation beim Kind mit vollem Magen

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