Practices of Rapid Sequence Induction for Prevention of Aspiration-An International Declarative Survey

Abstract

Background/Objectives: Rapid sequence induction (RSI) for the prevention of aspiration is a frequent clinical situation during anesthesia. The lack of international guidelines on this topic may lead to differences in practices. The aim of this survey is to identify the clinical practices in RSI among practitioners at an international level. Methods: International declarative survey across the ESAIC network. Results: A total of 491 respondents in 61 countries, 74% of them were seniors and 42% with over 20 years of experience. Most of the practitioners (87%) performed preoxygenation under a high flow of oxygen (>10 L/min) with no PEEP and no pressure support and 69% use opioids in most cases of RSI. The Sellick maneuver was used by 42% of respondents. RSI was used in most situations at high risk of aspiration (bowel obstruction, trauma within 6 h after the last meal, caesarian section). RSI was used in 53% of cases of appendicectomy in the absence of vomiting. Conversely, 29% did not use RSI in cases of symptomatic esophageal reflux. A total of 11% encountered at least one episode of grade IV anaphylaxis to succinylcholine or rocuronium and 24% aspiration pneumonia. Conclusions: Our results support the need for international guidelines on RSI to limit differences between practitioners and countries.

Keywords: anesthesia; aspiration; pneumonia; rapid sequence induction and intubation; surveys and questionnaires.