Complications during rapid sequence induction of general anesthesia in children: a benchmark study

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Published on: October 16, 2013

Frank J Gencorelli1, Ryan G Fields, Ronald S Litman

  • 1Department of Anesthesiology, Hospital of the University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Paediatric Anaesthesia
|March 27, 2010
PubMed

Insights

Rapid sequence intubation (RSI) in children is generally safe, with a 1.7% rate of difficult intubation and 3.6% experiencing transient desaturation. Severe hypoxemia was more common in children under 20 kg, but no long-term complications occurred.

Area of Science:

  • Pediatric Anesthesiology
  • Emergency Medicine
  • Critical Care

Background:

  • Rapid sequence intubation (RSI) is increasingly used outside the operating room by non-anesthesiologists.
  • There is a lack of established benchmarks for intubation success and complication rates in pediatric RSI.
  • This study addresses the need for data on pediatric RSI outcomes.

Purpose of the Study:

  • To determine the incidence of complications during pediatric RSI.
  • To establish a benchmark for RSI in children for other institutions and non-anesthesiologists.
  • To analyze factors influencing complications in pediatric RSI.

Main Methods:

  • Retrospective cohort analysis of 1070 children aged 3-12 years undergoing RSI.
  • Data collected from 2001 to 2006 in a tertiary care children's hospital.
  • Complications analyzed included difficult intubation, hypoxemia, hypotension, and bradycardia.

Main Results:

  • Difficult intubation occurred in 1.7% of cases, with all patients eventually intubated.
  • Transient oxyhemoglobin desaturation (SpO2 80-89% or <80%) occurred in 3.6% of patients.
  • Severe hypoxemia was more frequent in children weighing less than 20 kg (P < 0.001).

Conclusions:

  • Pediatric RSI in this cohort demonstrated a low incidence of difficult intubation and transient desaturation.
  • Children under 20 kg represent a higher risk group for severe hypoxemia during RSI.
  • No instances of failed intubation or long-term complications were reported, supporting RSI's safety in pediatric populations.
Abstract

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