Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia

Vanner, R. G.; Pryle, B. J.; O'dwyer, J. P.; Reynolds, F.

doi:10.1111/j.1365-2044.1992.tb02215.x

Cited by 77 publications

(32 citation statements)

References 31 publications

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“…Further, most intravenous induction drugs and opioids reduce esophageal sphincter tone, thus increasing the risk of regurgitation. 41,42 The goal of RSI therefore is to achieve a state that allows tracheal intubation but minimizes the time that patients are at risk for regurgitation and aspiration. The generally accepted practice regarding drug administration during RSI is rapid administration of predetermined doses.…”

Section: Should All Drugs Be Rapidly Administered During Rsi?mentioning

confidence: 99%

No evidence for decreased incidence of aspiration after rapid sequence induction

Neilipovitz

Crosby

2007

Can J Anesth/J Can Anesth

147

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Purpose:The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management. Source:In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed. OVID's therapy (sensitivity) algorithm was used to maximize the detection of randomized trials while excluding non-randomized research. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search. Principal findings:A total of 184 clinical trials were identified of which 163 were randomized controlled trials (RCTs). Of these clinical trials, 126 evaluated different drug regimens with 114 being RCTs. Only 21 clinical trials evaluated non-pharmacologic aspects of the RSI with 18 RCTs identified. A parallel search found 52 trials evaluating cricoid pressure (outside of the context of an RSI technique) with 44 classified as RCTs. Definitive outcomes such as prevention of aspiration and mortality benefit could not be evaluated from the trials. Likewise, the impact on adverse outcomes of the different components of RSI could not be ascertained. Conclusion:An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.

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Section: Should All Drugs Be Rapidly Administered During Rsi?mentioning

confidence: 99%

No evidence for decreased incidence of aspiration after rapid sequence induction

Neilipovitz

Crosby

2007

Can J Anesth/J Can Anesth

147

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“…An alternative method would be to titrate the doses of drugs over a more prolonged time period. The rationale for rapidly administering pre-determined doses is that the majority of hypnotics and opioids reduce both the upper and the lower oesophageal sphincter (LES) tone 11,12 and thus increase the risk of regurgitation. The goal of maximal injection of speed is to rapidly achieve a state of anaesthesia, which allows fast tracheal intubation and in this way reduces the time during which patients are at risk of gastric aspiration.…”

Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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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.

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“…Patients who have a "full stomach" are at risk of aspiration during sedation or general anesthesia due to reduction of the tonus of the lower esophageal sphincter and also protective airway reflexes. 6,7 Certain factors have been associated with the severity of the evolution of patients suffering from pulmonary aspiration, including the volume, nature and the pH of the aspirated material. [8][9][10][11] The preoperative assessment of the risk of pulmonary aspiration is essentially based on the patient's history, and clinical management typically follows the fasting recommendations of the current guidelines.…”

mentioning

confidence: 99%

Qualitative and quantitative ultrasound assessment of gastric content

Bisinotto

Pansani

Silveira

et al. 2017

Rev. Assoc. Med. Bras.

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Objective: Pulmonary aspiration of the gastric contents is one of the most feared complications in anesthesia. Its prevention depends on preoperative fasting as well as identification of risky patients. A reliable diagnostic tool to assess gastric volume is currently lacking. The aim of this study performed on volunteers was to evaluate the feasibility of ultrasonography to identify qualitative and quantitative gastric content. Method: A standardized gastric scanning protocol was applied on 67 healthy volunteers to assess the gastric antrum in four different situations: fasting, after ingesting clear fluid, milk and a solid meal. A qualitative and quantitative assessment of the gastric content in the antrum was performed by a blinded sonographer. The antrum was considered either as empty, or containing clear or thick fluid, or solids. Total gastric volume was predicted based on a cross-sectional area of the antrum. A p-value less than 0.05 was considered statistically significant. Results: For each type of gastric content, the sonographic characteristics of the antrum and its content were described and illustrated. Sonographic qualitative assessment allowed to distinguish between an empty stomach and one with different kinds of meal. The predicted gastric volume was significantly larger after the consumption of any food source compared to fasting. Conclusion: Bedside sonography can determine the nature of gastric content. It is also possible to estimate the difference between an empty gastric antrum and one that has some food in it. Such information may be useful to estimate the risk of aspiration, particularly in situations when prandial status is unknown or uncertain.

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Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia

Cited by 77 publications

References 31 publications

No evidence for decreased incidence of aspiration after rapid sequence induction

No evidence for decreased incidence of aspiration after rapid sequence induction

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Qualitative and quantitative ultrasound assessment of gastric content

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