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Published on: January 17, 2011
Controlled rapid sequence induction and intubation - an analysis of 1001 children
Diego Neuhaus1, Achim Schmitz, Andreas Gerber
1Department of Anesthesia, University Children's Hospital, Zurich, Switzerland. diego.neuhaus@kispi.uzh.ch
Insights
Controlled rapid sequence induction and intubation (cRSII) with gentle facemask ventilation is a safer pediatric airway management technique. This method supports stable cardiorespiratory conditions and minimizes aspiration risk in children.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Critical Care Medicine
Background:
- Classic rapid sequence induction poses risks for pediatric patients due to limited apnea tolerance.
- Gentle facemask ventilation before intubation, as in controlled rapid sequence induction and intubation (cRSII), may offer a safer alternative.
- Pediatric patients require specialized approaches for airway management during anesthesia induction.
Purpose of the Study:
- To evaluate the safety and efficacy of controlled rapid sequence induction and intubation (cRSII) in a large pediatric cohort.
- To analyze cardiorespiratory parameters, intubation conditions, and adverse events associated with cRSII.
- To determine the incidence of gastric regurgitation and pulmonary aspiration during cRSII in children.
Main Methods:
- Retrospective cohort analysis of 1001 pediatric patients undergoing cRSII.
- Standardized institutional protocol for cRSII from 2007 to 2011.
- Review of electronic patient data for vital signs, intubation success, and respiratory events.
Main Results:
- cRSII demonstrated a low incidence of hypoxemia (0.8% combined moderate/severe).
- No bradycardia or hypotension occurred; gastric regurgitation was rare (0.1%) with no pulmonary aspiration.
- Difficult intubation occurred in only 0.5% of patients, with no evidence of silent aspiration.
Conclusions:
- Controlled rapid sequence induction and intubation (cRSII) with pre-intubation ventilation ensures stable cardiorespiratory status in pediatric patients.
- This technique is effective for airway management, even in children with a full stomach.
- cRSII appears to be a safe method with a low risk of pulmonary aspiration in pediatric anesthesia.
Background:
Classic rapid sequence induction puts pediatric patients at risk of cardiorespiratory deterioration and traumatic intubation due to their reduced apnea tolerance and related shortened intubation time. A 'controlled' rapid sequence induction and intubation technique (cRSII) with gentle facemask ventilation prior to intubation may be a safer and more appropriate approach in pediatric patients. The aim of this study was to analyze the benefits and complications of cRSII in a large cohort.
Methods:
Retrospective cohort analysis of all patients undergoing cRSII according to a standardized institutional protocol between 2007 and 2011 in a tertiary pediatric hospital. By means of an electronic patient data management system, vital sign data were reviewed for cardiorespiratory parameters, intubation conditions, general adverse respiratory events, and general anesthesia parameters.
Results:
A total of 1001 patients with cRSII were analyzed. Moderate hypoxemia (SpO2 80-89%) during cRSII occurred in 0.5% (n = 5) and severe hypoxemia (SpO2 <80%) in 0.3% of patients (n = 3). None of these patients developed bradycardia or hypotension. Overall, one single gastric regurgitation was observed (0.1%), but no pulmonary aspiration could be detected. Intubation was documented as 'difficult' in two patients with expected (0.2%) and in three patients with unexpected difficult intubation (0.3%). The further course of anesthesia as well as respiratory conditions after extubation did not reveal evidence of 'silent aspiration' during cRSII.
Conclusion:
Controlled RSII with gentle facemask ventilation prior to intubation supports stable cardiorespiratory conditions for securing the airway in children with an expected or suspected full stomach. Pulmonary aspiration does not seem to be significantly increased.
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