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Published on: November 2, 2015
Comparison of Incidence of hypoxia during modified rapid sequence induction and an alternative technique: a
Ji Sun1, Xing-Huan Li1, Yun-Xia Zuo1
1Department of Anesthesiology and Translational Medical Neuroscience Center, West China Hospital, Sichuan University Chengdu, Sichuan 610041, China.
Insights
This study found that sevoflurane-based deep sedation with spontaneous breathing is a safe alternative to modified rapid sequence induction for pediatric patients at high risk of aspiration. Both methods showed similar outcomes regarding hypoxemia and reflux.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Critical Care Medicine
Background:
- Children at high risk for pulmonary aspiration require careful airway management during anesthesia induction.
- Traditional rapid sequence induction carries risks, necessitating evaluation of alternative techniques.
Purpose of the Study:
- To compare the safety and efficacy of a spontaneous breathing maintained induction technique versus a modified rapid sequence induction for children at high risk of aspiration.
- To assess the incidence of hypoxemia, pulmonary aspiration, and gastroesophageal reflux during intubation.
Main Methods:
- A prospective, randomized, placebo-controlled study involving 165 children at high risk for aspiration.
- Children were allocated to either spontaneous breathing maintained induction (Group S) or modified rapid sequence induction (Group C).
- Primary outcome was hypoxemia (SpO2<90%); secondary outcomes included aspiration, reflux, and adverse events.
Main Results:
- No significant difference in hypoxemia incidence between Group C (25.9%) and Group S (14.8%), P=0.079.
- Severe hypoxemia was not significantly different (6.2% vs. 2.5%, P=0.246).
- Gastroesophageal reflux rates were similar between groups (4.93% vs. 2.47%, P=0.552), with no witnessed aspirations.
Conclusions:
- Sevoflurane-based deep sedation with spontaneous respiration is a viable alternative to modified rapid sequence induction for high-risk pediatric patients.
- This technique does not appear superior but offers comparable safety regarding hypoxemia and reflux.
- It provides a valuable option for anesthesia induction in pediatric patients with predicted aspiration risk.
Background:
We evaluated the effects and safety of an alternative technique for rapid sequence intubation in children predicting to have high risk of pulmonary aspiration in this prospective, randomized, placebo-controlled study.
Methods:
One hundred sixty-five children predicting to have high risk of pulmonary aspiration were randomly allocated to spontaneous breathing maintained induction and intubation group (Group S) and the modified rapid sequence group (Group C). The primary outcome was the incidence of hypoxemia around the intubation period, which was defined as SpO2<90% at any time during the induction and 10 min after the endotracheal intubation. Secondary outcomes included the incidence of pulmonary aspiration, gastroesophageal reflux and other major adverse events associated with the induction and intubation.
Results:
There were no differences in the incidence of hypoxemia around the intubation period between Group C and Group S; 25.9% vs. 14.8% (P=0.079). The incidence of severe hypoxemia appeared higher in Group C than Group S but not statistical significance, 6.2% vs. 2.5% (P=0.246). Simultaneously, gastroesophageal reflux (upper esophageal pH≤4) was detected in 4.93% children in Group C and 2.47% in group S, which was not significantly different between the two groups (P=0.552). There were no witnessed aspirations in all subjects.
Conclusion:
Sevoflurane based deep sedation with spontaneous respiration maintained technique is not superior to modified rapid sequence induction but can be an alternative technique for anesthesia induction for those predicting to have high risk of aspiration in children.
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