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.