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Current practice of rapid sequence induction in the United Kingdom : a national survey
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Sajayan, A., Wicker, J., Ungureanu, N., Mendonca, C., Kimani, Peter K. and Asai, T. (2016) Current practice of rapid sequence induction in the United Kingdom : a national survey. British Journal of Anaesthesia, 117 (Supplement 1). i69-i74. doi:10.1093/bja/aew017
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Official URL: http://dx.doi.org/10.1093/bja/aew017
Abstract
Background
The ‘classical’ technique of rapid sequence induction (RSI) was described in 1970. With the introduction of new drugs and equipment in recent years, a wide variation in this technique has been used. The role of cricoid pressure is controversial due to the lack of scientific evidence. Moreover, gentle mask ventilation has been recommended in situations such as obesity and critically ill patients, to prevent hypoxaemia during the apnoeic period. In identifying multiple techniques, we conducted a national postal survey to establish the current practice of RSI in the UK.
Methods
A survey consisting of 17 questions was created and posted to 255 National Health Service (NHS) hospitals in the UK. We included two copies of the questionnaire in each envelope; one to be completed by the airway lead and the other by a trainee in the same department. The difference in responses from consultants and trainees were assessed using the chi-squared test and the Fisher's exact test.
Results
In total we received 272 responses (response rate 53%) of which 266 (58% from consultants and 42% from trainees) were analysed. A majority of the respondents (67.7%) pre-oxygenated by monitoring end-tidal oxygen concentration and 76.3% of the respondents use 20–25° head up tilt for all RSIs. Propofol is the most commonly used induction agent (63.9% of all respondents). Opioid has been used by 80.5% of respondents and only 17.7% of respondents use suxamethonium for all cases and others choose rocuronium or suxamethonium based on clinical situation. Although 92% of anaesthetists use cricoid pressure, 83% of them never objectively measure the force used. During apnoeic period 17% of the respondents use gentle mask ventilation.
Conclusions
Our survey demonstrated a persistent variation in the practice of RSI amongst the anaesthetists in the UK. The ‘classical’ technique of RSI is now seldom used. Increasing awareness of optimising oxygenation during apnoeic period and wider use of newer drugs such as propofol, rocuronium, and opioids has driven the current practice of RSI.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RD Surgery | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Anesthesiology -- Great Britain, Anesthesiologists -- Great Britain | ||||||
| Journal or Publication Title: | British Journal of Anaesthesia | ||||||
| Publisher: | Oxford University Press | ||||||
| ISSN: | 0007-0912 | ||||||
| Official Date: | 24 February 2016 | ||||||
| Dates: |
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| Volume: | 117 | ||||||
| Number: | Supplement 1 | ||||||
| Page Range: | i69-i74 | ||||||
| DOI: | 10.1093/bja/aew017 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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