Modified rapid-sequence induction of anesthesia: a survey of current clinical practice.

The purpose of this study was to identify the use of rapid-sequence induction (RSI) and its hybrids. For the study, 67 Certified Registered Nurse Anesthetists at 1 hospital completed a survey describing their experience using a modified technique for patients with a moderately increased risk of regurgitation and aspiration. Patient selection criteria and the use of aspiration prophylaxis, preoxygenation, cricoid pressure, and positive-pressure ventilation were evaluated. In contrast with routine induction and standard RSI techniques, the modified RSI technique consisted of aspiration prophylaxis, preoxygenation, application of cricoid pressure, and positive-pressure ventilation. The survey revealed that a modification of standard RSI is used commonly in clinical practice. These modified RSI techniques are not standardized, as variation was noted in the delivery of positive pressure ventilation. Further study is necessary to identify widespread use of modified RSI techniques and to clarify the risks and benefits of modified RSI.

[1]  I. Smith,et al.  Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation , 1999, Anaesthesia.

[2]  R. Vanner,et al.  Safe use of cricoid pressure , 1999, Anaesthesia.

[3]  C. Coté,et al.  Rocuronium Versus Succinylcholine: Are They Equally Effective During Rapid-Sequence Induction of Anesthesia? , 1998, Anesthesia and analgesia.

[4]  K. Olkkola,et al.  Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia , 1998, Anaesthesia.

[5]  T. Fuchs-Buder,et al.  Thiopental or etomidate for rapid sequence induction with rocuronium. , 1998, British journal of anaesthesia.

[6]  M. Ballin,et al.  Subconjunctival haemorrhage following rapid sequence induction in pregnancy. , 1998, Anaesthesia.

[7]  S. Fletcher,et al.  Fracture of the cricoid cartilage after Sellick's manoeuvre. , 1996, British journal of anaesthesia.

[8]  Njoku Db,et al.  Use care when injecting rocuronium and thiopental for rapid sequence induction and tracheal intubation. , 1995 .

[9]  L. Molbegott.  The precipitation of rocuronium in a needleless intravenous injection adaptor. , 1995, Anesthesiology.

[10]  D. Njoku,et al.  Use care when injecting rocuronium and thiopental for rapid sequence induction and tracheal intubation. , 1995, Anesthesiology.

[11]  Ronald D. Miller,et al.  Onset and Duration of Rocuronium and Succinylcholine at the Adductor Pollicis and Laryngeal Adductor Muscles in Anesthetized Humans , 1994, Anesthesiology.

[12]  Ronald D. Miller,et al.  Comparison of Rocuronium, Succinylcholine, and Vecuronium for Rapid‐sequence Induction of Anesthesia in Adult Patients , 1993, Anesthesiology.

[13]  S. Silverman,et al.  Rapid-sequence orotracheal intubation: a comparison of three techniques. , 1990, Anesthesiology.

[14]  R. Cicala,et al.  An alternative method of paralysis for rapid-sequence induction. , 1988, Anesthesiology.

[15]  E. Lawes,et al.  Inflation Pressure, Gastric Insufflation and Rapid Sequence Induction , 1987, British journal of anaesthesia.