RSI in pediatric anesthesia - is it used by nonpediatric anesthetists? A survey from south-west England.

Abstract

BACKGROUND:

Rapid sequence induction (RSI) is the 'gold standard' technique for preventing aspiration of gastric contents during induction of anesthesia in unfasted patients. We conducted a survey to discover whether the conduct of RSI in children varies amongst anesthetists and if practice alters in relation to the time since training or degree of ongoing experience.

METHODS:

Six hundred and fifteen questionnaires were sent to anesthetists in the south-west of England.

RESULTS:

The response rate was 61%. Preoxygenation was utilized by 83% of anesthetists for infants whereas 94% preoxygenated schoolchildren, P < 0.001. Only 59% of respondents used cricoid pressure in infants, compared with 96% in schoolchildren, P < 0.001. Propofol was the induction agent of choice for all anesthetists, although thiopentone was used more in infants (35%) than schoolchildren (9%), P < 0.001. Suxamethonium was widely used in all children. All anesthetists intubated patients for pyloromyotomy, 50% using cricoid pressure. RSI was performed by 86% of anesthetists for appendicectomy, with consultants most likely to deviate from a standard RSI. Sixty percent of anesthetists intubated for manipulation of forearm, 72% performing an RSI, 53% intubated for scrotal exploration, but only 42% performed an RSI.

CONCLUSIONS:

Classical RSI is used for children by most anesthetists in south-west England. RSI is modified for infants especially by more recently trained consultants. Suxamethonium is used less by consultant anesthetists. Whilst RSI is performed for appendicectomy there is a large variation in techniques for anesthetizing children for MUA and scrotal exploration which is independent of the grade of anesthetist.

• Authors: Judith Stedeford, Peter Stoddart
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 17 Issue 3 Pg. 235-42 (Mar 2007) ISSN: 1155-5645 [Print] France
• PMID: 17263738 (Publication Type: Journal Article)

Chemical References

• Succinylcholine

Topics

• Anesthesia, General (methods)
• Anesthesiology (education)
• Chi-Square Distribution
• Child
• Cricoid Cartilage
• England
• Humans
• Infant
• Minor Surgical Procedures
• Oxygen Inhalation Therapy (statistics & numerical data)
• Pediatrics
• Pressure (adverse effects)
• Professional Practice (statistics & numerical data)
• Respiratory Aspiration (prevention & control)
• Succinylcholine (therapeutic use)
• Surveys and Questionnaires
• Time Factors