Techniques of rapid sequence induction and intubation at a university teaching hospital

Gebremedhn, Endale Gebreegziabher; Gebeyehu, Kefale D.; Ayana, Hintsawit A.; Oumer, Keder Essa; Ayalew, Hulgize N.

doi:10.5847/wjem.j.issn.1920-8642.2014.02.005

Cited by 3 publications

(5 citation statements)

References 17 publications

(13 reference statements)

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“…21 This may occur when those tasked with applying CP have inadequate knowledge of the correct procedure. [22][23][24] The findings of the present study indicate that major trauma patients undergoing RSI are still at risk of regurgitation and aspiration; overall, 63.3% of respondents were aware of aspiration occurring at induction of anaesthesia in trauma patients, with 25.3% admitting to personal experience. Interestingly, the rate of awareness of aspiration appears to be less in the UK than Europe (38.5% vs. 71.2%).…”

Section: Discussionmentioning

confidence: 89%

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The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

Gwinnutt

Robinson

2015

Trauma

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Introduction: There is ongoing debate and conflicting evidence surrounding the place of cricoid pressure (CP) as part of a rapid sequence induction (RSI) of anaesthesia. This study investigated the current use of CP during trauma RSI and compared reported practice in the UK with the rest of Europe. Methods: An anonymised, web-based survey was sent to all clinicians registered as European Trauma Course instructors. Results: CP use was reported by 83.1% of UK respondents and 39.4% from the rest of Europe, with an overall reported use of 49.8%. Anaesthetists use CP less commonly (35.6%) than clinicians from other specialties (63.6%). The most common reason given for not using CP (76.7%) was a perceived lack of evidence of effectiveness. Conclusion: Generally the use of CP appears to be in decline with only half of all clinicians reporting to use it; however it remains much more commonly used in the UK than the rest of Europe.

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Section: Discussionmentioning

confidence: 89%

“…21 This may occur when those tasked with applying CP have inadequate knowledge of the correct procedure. 22–24…”

Section: Discussionmentioning

confidence: 99%

The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

Gwinnutt

Robinson

2015

Trauma

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“…The main reason for missing to apply the standards correctly may be secondary to lack of local working guidelines. Oxygen desaturation is the commonest complication for emergency patients, and greater emphasis should be put on formal preoxygenation as an essential part of RSI [1, 15].…”

Section: Discussionmentioning

confidence: 99%

“…In patients who are liable to the risk of pulmonary aspiration, airway control is the primary and first concern for the anesthetists both in emergency and elective surgical procedures and in any occasion of need of airway protection [1].…”

Section: Introductionmentioning

confidence: 99%

Audit on Current Practice of Rapid Sequence Induction and Intubation of Anesthesia in the University of Gondar Hospital, Northwest Ethiopia, 2018

Mollalign

Gebregzi

Kassahun

et al. 2019

Anesthesiology Research and Practice

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Background In patients who are liable to the risk of pulmonary aspiration, airway control is the primary and first concern for the anesthetists both in emergency and elective surgical procedures. Rapid sequence induction is universally required in any occasion of emergent endotracheal intubation needed for unfasted patients or patients' fasting status is unknown. Methods institutional-based prospective observational study was conducted from December 2017 to January 2018 in all elective and emergency adult or pediatric patients with a risk of pulmonary aspiration who were operated under general anesthesia with rapid sequence induction and intubation during the audit period. Result A total of 35 patients were operated during the study period. Of these, 31 (88.57%) patients were adults and 4 (11.43%) patients were pediatrics. Most of the patients were emergency (29 (82.857%)), and the rest were elective (6 (17.142%)). Conclusion Most anesthetists were good at preparing all available monitoring and drugs, making sure that IV line is well-functioning, preparing suction with a suction machine, preoxygenation, application of cricoid pressure, and checking the position of the ETT after intubation was performed. Preparing difficult airway equipment during planning of rapid sequence induction and intubation, giving roles and told to proceed their assigned role for the team, attempt to ventilate with a small tidal volume, and routine use of bougie or stylet to increase the chance of success of intubation needed improvement.

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“…[1,2] Rapid sequence intubation (RSI) is the standard for defi nitive airway management in these patients. [3,4] Even with RSI, aspiration of gastric contents is not avoided when vomiting or regurgitation occurs at an interval before tracheal intubation. [5] This problem remains unsolved despite the fact that aspiration is a life-threatening complication associated with tracheal intubation in emergency patients.…”

Section: Introductionmentioning

confidence: 99%

Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

Takenaka

Aoyama²

2016

World Journal of Emergency Medicine

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BACKGROUND: Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients. Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications. Although it has been considered that aspiration can be prevented in the lateral position, few studies have evaluated the ability to prevent aspiration. Moreover, this position is not always a favorable position for tracheal intubation. If aspiration can be prevented in a clinically relevant semi-lateral position, it may be advantageous. We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model. METHODS:A manikin's head was placed in the neutral, simple extension, or sniffing position. The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0º to 90º in 10º increments. The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS: Pulmonary aspiration was prevented at the ≥70º, ≥80º, and 90º semi-lateral positions in the neutral, simple extension, and sniffi ng positions, respectively. The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented. CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation. Prevention of aspiration was diffi cult within clinically relevant semi-lateral positions.

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Techniques of rapid sequence induction and intubation at a university teaching hospital

Cited by 3 publications

References 17 publications

The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

Audit on Current Practice of Rapid Sequence Induction and Intubation of Anesthesia in the University of Gondar Hospital, Northwest Ethiopia, 2018

Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

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