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

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

Abstract

Abstract:

BACKGROUND: Rapid sequence induction and intubation (RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw difficulties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.
METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.
RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients (92.2%), and appropriate drugs were not used for RSII in 73 patients (52.1%), equipments for difficult intubation in 21 (15%), suction machines with catheter not connected and turned on in 122 (87.1%), ventilation for patients after induction and before intubation in 41 (29.3%), cricoid pressure released before cuff inflation in 12 (12.1%), and difficult intubation in 8 (5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94 (67.1%) patients, but cricoid pressure was not used in 46 (32.9%) patients.
CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.

Key words: Rapid sequence, Induction, Intubation, Pulmonary aspiration, General anesthesia

Endale G. Gebremedhn, Kefale D. Gebeyehu, Hintsawit A. Ayana, Keder E. Oumer, Hulgize N. Ayalew. Techniques of rapid sequence induction and intubation at a university teaching hospital[J]. World Journal of Emergency Medicine, 2014, 5(2): 107-111.

Figures/Tables 3

Table 1

Table 2

Table 3

References 15

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Factors	Frequency	Percent
Sex
Male	72	51.4
Female	68	48.6
Age (yr)
1-12	19	13.3
13-18	6	9.2
19-50	87	61.1
>50	28	19.7
OPV status
OPV1	111	79.3%
OPV2	21	15%
OPV3	8	5.7%
OPV4	0	0%
ASA status
ASA1	114	81.4%
ASA2	8	5.7%
ASA3	7	5%
ASA4	11	7.8%
Documented preoperative respiratory disease
Yes	0	0%
No	100	100%
Documented preoperative oxygen desaturation
Yes	0	0%
No	100	100%
The year of experience of anesthetists who handled patients	Patients handled
<1 yr	13	9.3
1-2 yr	58	41.4
3-5 yr	58	41.4
>5 yr	11	7.9

Factors	Frequency	Percent
Type of surgery
Emergency	118	84.3
Elective	22	15.7
Suction with a catheter prepared
Yes	111	79.3
No	29	20.7
Suction with a catheter connected and turned on
Yes	18	12.9
No	122	87.1
Anesthetist ventilates the patient after induction and before intubation
Yes	41	29.3
No	99	70.7
Cricoids pressure applied
Yes	94	67.1
No	46	32.9
Time of cricoids pressure applied
Before induction	17	12.1
After induction but before loss of consciousness	43	30.7
After induction and loss of consciousness	34	24.3
Time of cricoids pressure released
Before cuff inflation	12	8.6
After cuff inflation	82	58.6
Type of induction drug
Ketamine, halothane & sux	1	0.7
Ketamine & sux	101	72.1
Propofol & sux	3	2.1
Thiopentone & sux	35	24.9

Factors	The effects of the years of experiences of anesthetists on the techniques of RSII
Factors	< 1 year	1-2 years	3-5 years	>5 years
No prophylaxis for pulmonary aspiration	50 (35.7)	41 (29.3)	25 (17.9)	14 (10)
Appropriate drug preparation for RSII	9 (6.4)	12 (8.6)	21 (15)	33 (23.6)
Preparation of suction machine with catheter	11 (7.9)	14 (10)	37 (26.4)	49 (35)
Equipment prepared for difficult intubation	5 (3.6)	11 (7.9)	32 (22.9)	61(43.6)
Suction machine with catheter not connected and turned on at induction of anaesthesia	67 (47.9)	38 (27.1)	13 (9.3)	4 (2.9)
Cricoid pressure applied correctly	13 (9.3)	18 (12.9)	27 (19.3)	36 (25.7)
Cricoid pressure not applied at all	19 (13.6)	12 (8.6)	9 (6.4 )	6 (4.3)
Ventilated patients immediately after induction but before endotracheal intubation	21 (15)	13 (9.3)	5 (3.6)	2 (1.4)
Released cricoid pressure before ETT cuff inflation	6 (4.3)	3 (2.1)	2 (1.4)	1 (0.7)
Number of patients who developed moderate oxygen desaturation during RSII	5 (3.6)	2 (1.4)	2 (1.4)	1 (0.7)
Number of patients who developed severe oxygen desaturation during RSII	2 (1.4)	2 (1.4)	1 (0.7)	1 (0.7)
Number of difficult intubation cases happened	3 (2.1)	3 (2.1)	1 (0.7)	1 (0.7)

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