Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Abstract

Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

The anesthetic management of emergency general surgery cases: A retrospective analysis

“…Elektif cerrahi ile karşılaştırıldığında, acil cerrahi hastalarında morbidite ve mortalite daha yüksek oranda görülmektedir 1,5 . Özkan ve ark.…”

“…Ancak son dönemlerde daha az yan etki potansiyeli olduğu için hızlı seri indüksiyonda rokuronyum kullanımı artmaktadır. Opiod kullanımı ile de entübasyona olan hemodinamik yanıt baskılanabilir 1 . Çalışmamızda, literatüre benzer bir şekilde indüksi-yonda propofol + rokuronyum + opioid kombinasyonunun tercihi fazla olmuştur.…”

“…Çalışmamızda, idamede inhalasyon anestezisi daha fazla kullanıldı. Bu olasılıkla total intravenöz anestezi için kullanılan ajanların-özellikle propofol-hipotansif etkisinden kaçınmak için olabilir 1 . Analjezik olarak idamede daha çok narkotik analjezik kullanılması, ameliyat odamızda yıllar içerisinde azot protoksit kullanımı-nın giderek azalması ile ilişkilendirilebilir.…”

Anaesthesia and pre‐hospital emergency medicine

“…Many publications and texts state that ketamine worsens secondary brain injury through a rise in intracranial pressure. More recent evidence suggests that secondary brain injury is lessened, not only by the avoidance of systemic hypotension commonly seen with other induction agents, but also because ketamine attenuates the haemodynamic response to intubation and appears to also have neuroprotective properties, provided that normocapnia is achieved with controlled mandatory ventilation [42][43][44][45].…”

Use of Succinylcholine by Anaesthetists in Turkey: A National Survey

“…Because SCh stimulates the muscarinic and nicotinic receptors in a similar fashion to acetylcholine, it has unwanted and possibly life-threatening side effects such as bradycardia and asystole in the cardiovascular system; fasciculations and related muscle pain in the skeletal system; temporary increases in intragastric, intraocular and intracranial pressure; lengthened paralysis due to plasma pseudocholine esterase deficiency or depletion and malignant hyperthermia (1,8). Due to SCh's shorter effect, it is a good choice as a muscle relaxant for situations with expected difficult intubation, such as morbid obesity and obstetric surgeries, to prevent life-threatening hypoxia in situations with a possible risk of aspiration of stomach contents such as the acute abdomen, ileus and emergency trauma surgeries and for aggressive airway management (9,10).…”