Rapid sequence induction: An international survey

Abstract

BACKGROUNDRapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction.OBJECTIVEThe primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations.DESIGNOnline survey.SETTINGSA total of 56 countries.PARTICIPANTSMembers of the European Society of Anaesthesiology.MAIN OUTCOME MEASURESThe aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia.RESULTSFrom 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% O2for 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).CONCLUSIONWe found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT03694860.