Sajayan A, Wicker J, Ungureanu N, Mendonca C, Kimani PK. Current practice of rapid sequence induction of anaesthesia in the UK - a national survey. Br J Anaesth. 2016 Sep;117 Suppl 1:i69-i74. doi: 10.1093/bja/aew017. PubMed PMID: 26917599.
The 'classical' technique of rapid sequence induction (RSI) of anesthesia was described almost 50 years ago. Since that time, new drugs, new equipment and new studies have led to enormous variation in RSI technique. In particular, the role of cricoid pressure remains controversial, lacking a solid evidenciary basis, while the classical prohibition of mask ventilation is now usually abandoned so as to avoid hypoxemia.
This study is a report of a postal survey to characterize the current practice of rapid sequence induction (RSI) amongst UK anesthetists. The authors received 272 responses. Most respondents used 20-25° head up tilt for all RSIs and most used propofol as the induction agent. 92% of the anesthetists used cricoid pressure but only 17% of the respondents used mask ventilation to prevent hypoxemia.
The authors concluded that there exists “persistent variation in the practice of RSI amongst the anaesthetists in the UK” and that the 'classical' RSI technique “is now seldom used.” The authors close by recommending the development of “consistent guidelines” for the practice of RSI.
MORE READING (alphabetical order)
Algie CM, Mahar RK, Tan HB, Wilson G, Mahar PD, Wasiak J. Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation. Cochrane Database Syst Rev. 2015 Nov 18;(11):CD011656. doi: 10.1002/14651858.CD011656.pub2. Review. PubMed PMID: 26578526.
Butler J, Sen A. Best evidence topic report. Cricoid pressure in emergency rapid sequence induction. Emerg Med J. 2005 Nov;22(11):815-6. Review. PubMed PMID: 16244348; PubMed Central PMCID: PMC1726598.
Istvan J, Belliveau M, Donati F. Rapid sequence induction for appendectomies: a retrospective case-review analysis. Can J Anaesth. 2010 Apr;57(4):330-6. doi: 10.1007/s12630-009-9260-1. PubMed PMID: 20049576.
Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anaesth. 2007 Sep;54(9):748-64. Review. PubMed PMID: 17766743.
Schlesinger S, Blanchfield D. Modified rapid-sequence induction of anesthesia: a survey of current clinical practice. AANA J. 2001 Aug;69(4):291-8. PubMed PMID: 11759367.
Schober P, Schwarte LA. Put pressure on the cricoid pressure. Emerg Med J. 2016 Nov 1. pii: emermed-2016-206294. doi: 10.1136/emermed-2016-206294. [Epub ahead of print] PubMed PMID: 27803126.
Trethewy CE, Burrows JM, Clausen D, Doherty SR. Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial. Trials. 2012 Feb 16;13:17. doi: 10.1186/1745-6215-13-17. PubMed PMID: 22336284; PubMed Central PMCID: PMC3296638.
The 'classical' technique of rapid sequence induction (RSI) of anesthesia was described almost 50 years ago. Since that time, new drugs, new equipment and new studies have led to enormous variation in RSI technique. In particular, the role of cricoid pressure remains controversial, lacking a solid evidenciary basis, while the classical prohibition of mask ventilation is now usually abandoned so as to avoid hypoxemia.
This study is a report of a postal survey to characterize the current practice of rapid sequence induction (RSI) amongst UK anesthetists. The authors received 272 responses. Most respondents used 20-25° head up tilt for all RSIs and most used propofol as the induction agent. 92% of the anesthetists used cricoid pressure but only 17% of the respondents used mask ventilation to prevent hypoxemia.
The authors concluded that there exists “persistent variation in the practice of RSI amongst the anaesthetists in the UK” and that the 'classical' RSI technique “is now seldom used.” The authors close by recommending the development of “consistent guidelines” for the practice of RSI.
MORE READING (alphabetical order)
Algie CM, Mahar RK, Tan HB, Wilson G, Mahar PD, Wasiak J. Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation. Cochrane Database Syst Rev. 2015 Nov 18;(11):CD011656. doi: 10.1002/14651858.CD011656.pub2. Review. PubMed PMID: 26578526.
Butler J, Sen A. Best evidence topic report. Cricoid pressure in emergency rapid sequence induction. Emerg Med J. 2005 Nov;22(11):815-6. Review. PubMed PMID: 16244348; PubMed Central PMCID: PMC1726598.
Istvan J, Belliveau M, Donati F. Rapid sequence induction for appendectomies: a retrospective case-review analysis. Can J Anaesth. 2010 Apr;57(4):330-6. doi: 10.1007/s12630-009-9260-1. PubMed PMID: 20049576.
Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anaesth. 2007 Sep;54(9):748-64. Review. PubMed PMID: 17766743.
Schlesinger S, Blanchfield D. Modified rapid-sequence induction of anesthesia: a survey of current clinical practice. AANA J. 2001 Aug;69(4):291-8. PubMed PMID: 11759367.
Schober P, Schwarte LA. Put pressure on the cricoid pressure. Emerg Med J. 2016 Nov 1. pii: emermed-2016-206294. doi: 10.1136/emermed-2016-206294. [Epub ahead of print] PubMed PMID: 27803126.
Trethewy CE, Burrows JM, Clausen D, Doherty SR. Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial. Trials. 2012 Feb 16;13:17. doi: 10.1186/1745-6215-13-17. PubMed PMID: 22336284; PubMed Central PMCID: PMC3296638.