Rapid Sequence Intubation
Conditions
Keywords
anesthetic induction, adult patients, hemodynamic disorders, arrythmia, cardiac arrest, pre-oxygenation, mean blood pressure
Brief summary
There is a great heterogeneity in the practice of rapid sequence induction in the operating room in the world. There are no recent data assessing the rate of implementation of the latest French formalized expert recommendations in clinical practice. In addition, the modalities for the management of haemodynamic disorders, particularly hypotensive disorders, during rapid sequence induction are not described in these recommendations, although these are frequent events with a non-zero morbidity mortality potential. The goal of this prospective, observational, multicenter, anesthetic study is to describe the clinical practice of French anesthesiologists regarding the prevention of severe hemodynamic disorders during rapid sequence anesthetic induction in adult patients. The primary outcome measure is the occurrence of a major haemodynamic disorder defined by a MBP ≤ 50 mmHg (or ≤ 40% of the reference value) and/or ≥ 110 mmHg and/or the occurrence of sustained arrhythmia not present at induction and/or cardiac arrest within the first 10 minutes after induction of anesthesia. The clinical practices of pre-oxygenation, induction and intubation of French anesthesiologists and compliance with the formalized expert recommendations of 2017 and 2018 will also be studied secondarily. The elements for the prevention of gastric fluid inhalation, the organization and equipment used, the anesthetic and non-anesthetic drugs used, the clinical and paraclinical neurological and cardio-respiratory parameters and the nature of the complications following anaesthetic induction will be collected up to the 10th post-induction minute.
Interventions
OTHERrapid sequence anesthetic induction
Rapid sequence induction and intubation (or crash induction) is a process for inducing general anesthesia when the patient is at a high risk of pulmonary aspiration. It aims at minimizing the time between giving the induction drugs and securing the tube, during which period the patient's airway is essentially unprotected.
Sponsors
Société Française d'Anesthésie et de Réanimation
Nantes University Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years' old * Procedure requiring general anesthesia with oro or nasotracheal intubation * Anesthetic management with indication of rapid sequence induction * No objection after oral and written information to the patient
Exclusion criteria
* Age \< 18 years' old * Impossible intubation planned * Preoperative respiratory distress (SpO2 \< 90% in ambient air) * Preoperative shock (MBP≤ 65 mmHg or vasopressive amines) * Preoperative coma defined by a Glasgow score ≤ 12/15 * Patient in cardiopulmonary arrest * Patients under guardianship or curatorship
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Occurrence of a major haemodynamic disorder | Within the first 10 minutes after induction of anesthesia | MBP ≤ 50 mmHg (or ≤ 40% of the reference value) and/or ≥ 110 mmHg and/or occurrence of a sustained arrhythmia (\> 1 min) not present at induction and/or cardiac arrest |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pre-anesthetic assessment of the risk of a full stomach | From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure | \- percentage of gastric ultrasound use |
| Assessment of the risk of a full stomach | From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure | \- percentage of presence and use of the Nasogastric Tube |
| Team involved in the rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- average number of individuals in the room participating in the performance of SRI |
| Preparation for rapide sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- Percentage of patients in supine position |
| Use of morphine for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage of use of morphine derivative prior to airway securisation |
| Induction therapeutics for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage of use of each of the following hypnotics: propofol, ketamine, thiopental, etomidate, midazolam, sevoflurane |
| Use of curare for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage of use of a curare |
| Use of vasopressive amine for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage and median dosage of vasopressive amine use for the prevention of low blood pressure |
| Use of filling solution for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage and median volume of use of a preventive vascular filling solution |
| Airway management for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- type of preoxygenation |
| Operator qualification for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentages of first operator with a medical degree, of trained nurses, and of medical resident performing the rapid sequence induction technique |
| Laryngoscopy for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage of use of a video laryngoscope as a 1st intention |
| Clinical pre-anesthesic assessment of the risk of a full stomach | From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure | \- percentage of clinical and/or imaging endpoints in favor of a full stomach |
| MBP complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of episode of MBP ≤ at 50 mmHg (or ≤ 40% of the baseline) |
| Tension complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of episode of MBP ≥ 110 mmHg |
| Rythmal complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- sustained arrhythmia (\> 1 minute) not present at induction |
| Cardiac complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- cardiac arrest |
| Intubation complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of intubations that required more than one laryngoscopy |
| Low tension-related complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage and median dosage of use of a vasopressive amine required for the treatment of low blood pressure (defined as a SBP \< 80 mmHg) |
| High tension-related complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of use of an antihypertensive drug or sedation-analgesia bolus for the treatment of high blood pressure (defined as SBP \> 160 mmHg) |
| Respiratory complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of respiratory complication defined by Spo2 \< 90% or the need for manual reventilation |
| Anaphylactic complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of Grade I, II, III or IV anaphylactic reaction |
| Inhalation complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of gastric fluid inhalation defined by the presence of non-salivary fluid or supraglottic solids during laryngoscopy |
| Immediate complications of ISR (< 10 minutes) | Within the first 10 minutes after induction of anesthesia | \- percentage of intraoperative deaths |
| Medical device used for rapid sequence induction technique | Within the first 10 minutes after induction of anesthesia | \- percentage of mandrel use at the first laryngoscopy |
Countries
France
Contacts
Primary ContactHugo Ingles, MD
Backup ContactNicolas Grillot, MD
Outcome results
None listed