Rapid sequence induction
Jozef Klučka, Martina Kosinová, Kai Zacharowski, Stefan De Hert, Milan Kratochvíl, Michaela Ťoukálková, Roman Štoudek, Hana Zelinková, Petr Štourač
Abstract
BACKGROUND: Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE: The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN: Online survey. SETTINGS: A total of 56 countries. PARTICIPANTS: Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES: The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS: From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION: We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03694860.