Document Detail

Controlled rapid sequence induction and intubation - an analysis of 1001 children.
MedLine Citation:
PMID:  23763293     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Classic rapid sequence induction puts pediatric patients at risk of cardiorespiratory deterioration and traumatic intubation due to their reduced apnea tolerance and related shortened intubation time. A 'controlled' rapid sequence induction and intubation technique (cRSII) with gentle facemask ventilation prior to intubation may be a safer and more appropriate approach in pediatric patients. The aim of this study was to analyze the benefits and complications of cRSII in a large cohort.
METHODS: Retrospective cohort analysis of all patients undergoing cRSII according to a standardized institutional protocol between 2007 and 2011 in a tertiary pediatric hospital. By means of an electronic patient data management system, vital sign data were reviewed for cardiorespiratory parameters, intubation conditions, general adverse respiratory events, and general anesthesia parameters.
RESULTS: A total of 1001 patients with cRSII were analyzed. Moderate hypoxemia (SpO2 80-89%) during cRSII occurred in 0.5% (n = 5) and severe hypoxemia (SpO2 <80%) in 0.3% of patients (n = 3). None of these patients developed bradycardia or hypotension. Overall, one single gastric regurgitation was observed (0.1%), but no pulmonary aspiration could be detected. Intubation was documented as 'difficult' in two patients with expected (0.2%) and in three patients with unexpected difficult intubation (0.3%). The further course of anesthesia as well as respiratory conditions after extubation did not reveal evidence of 'silent aspiration' during cRSII.
CONCLUSION: Controlled RSII with gentle facemask ventilation prior to intubation supports stable cardiorespiratory conditions for securing the airway in children with an expected or suspected full stomach. Pulmonary aspiration does not seem to be significantly increased.
Diego Neuhaus; Achim Schmitz; Andreas Gerber; Markus Weiss
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Publication Detail:
Type:  Journal Article     Date:  2013-06-14
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  23     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-04     Completed Date:  2014-02-07     Revised Date:  2014-02-12    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  734-40     Citation Subset:  IM    
Copyright Information:
© 2013 John Wiley & Sons Ltd.
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MeSH Terms
Anesthesia, Inhalation / adverse effects,  methods*
Anoxia / etiology
Child, Preschool
Cohort Studies
Infant, Newborn
Intubation, Intratracheal / adverse effects,  methods*
Laryngopharyngeal Reflux / etiology
Respiration, Artificial
Respiratory Aspiration of Gastric Contents / epidemiology,  prevention & control
Retrospective Studies
Treatment Outcome
Young Adult
Comment In:
Paediatr Anaesth. 2013 Dec;23(12):1225-6   [PMID:  24383605 ]

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