Related Experiment Video
Updated: Jan 21, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Risk of Hypoxemia by Induction Technique Among Infants and Neonates Undergoing Pyloromyotomy
Raymond S Park1,2, Sirirat Rattana-Arpa1,3, James M Peyton1,2
1From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Insights
Modified rapid sequence induction (mRSI) is safer than rapid sequence induction (RSI) for pyloromyotomy, significantly reducing hypoxemia risk in infants without increasing aspiration. Multiple intubation attempts also increase hypoxemia risk.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Pyloromyotomy requires airway securement, with a debate on using rapid sequence induction (RSI) versus modified RSI (mRSI).
- Limited evidence exists comparing RSI and mRSI for pyloromyotomy regarding aspiration risk and hypoxemia.
Purpose of the Study:
- To compare the incidence of hypoxemia during anesthetic induction between RSI and mRSI in patients undergoing pyloromyotomy.
- To evaluate the association between intubation attempts and hypoxemia in this patient population.
Main Methods:
- Retrospective review of medical records for 296 patients undergoing pyloromyotomy (May 2012-December 2018).
- Comparison of hypoxemia rates (SpO2 <90%) between RSI and mRSI cohorts using logistic regression.
- Analysis of complications and intubation success rates for both groups.
Main Results:
- Modified RSI (17%) was associated with significantly lower hypoxemia rates than RSI (30%) (P=.016).
- Multivariable analysis showed RSI increased hypoxemia risk (OR 2.8) and multiple intubation attempts significantly predicted hypoxemia (OR 11.4).
- Neonatal subgroup analysis revealed even higher hypoxemia risks with RSI (OR 6.5) and multiple intubation attempts (OR 18.1).
Conclusions:
- Modified RSI is associated with less hypoxemia compared to RSI in infants undergoing pyloromyotomy, with no increase in aspiration events.
- Multiple intubation attempts are a strong predictor of hypoxemia, particularly in neonates.
- Anesthetic management should consider modified RSI to minimize hypoxemia risk during pyloromyotomy.
Background:
In patients presenting for pyloromyotomy, most practitioners prioritize rapid securement of the airway due to concern for aspiration. However, there is a lack of consensus and limited evidence on the choice between rapid sequence induction (RSI) and modified RSI (mRSI).
Methods:
The medical records of all patients presenting for pyloromyotomy from May 2012 to December 2018 were reviewed. The risk of hypoxemia (peripheral oxygen saturation [Spo2], <90%) during induction was compared between RSI and mRSI cohorts for all patients identified as well as in the neonate subgroup by univariate and multivariable logistic regression analysis. Complications (aspiration, intensive care unit admission, bradycardia, postoperative stridor, and hypotension) and initial intubation success for both cohorts were also compared.
Results:
A total of 296 patients were identified: 181 in the RSI and 115 in the mRSI cohorts. RSI was associated with significantly higher rates of hypoxemia than mRSI (RSI, 30% [23%-37%]; mRSI, 17% [10%-24%]; P = .016). In multivariable logistic regression analysis of all patients, the adjusted odds ratio (OR) of hypoxemia for RSI versus mRSI was 2.8 (95% confidence interval [CI], 1.5-5.3; P = .003) and the OR of hypoxemia for multiple versus a single intubation attempt was 11.4 (95% CI, 5.8-22.5; P < .001). In multivariable logistic regression analysis of neonatal subgroup, the OR of hypoxemia for RSI versus mRSI was 6.5 (95% CI, 2.0-22.2; P < .001) and the OR of hypoxemia for multiple intubation versus single intubation attempts was 18.1 (95% CI, 4.7-40; P < .001). There were no induction-related complications in either the RSI and mRSI cohorts, and the initial intubation success rate was identical for both cohorts (78%).
Conclusions:
In infants presenting for pyloromyotomy, anesthetic induction with mRSI compared with RSI was associated with significantly less hypoxemia without an observed increase in aspiration events. In addition, the need for multiple intubation attempts was a strong predictor of hypoxemia. The increased risk of hypoxemia associated with RSI and multiple intubation attempts was even more pronounced in neonatal patients.
More Related Videos
Related Concept Videos
01:12Relative Risk
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:29Drug Dosing: Infants and Children
01:16Induction
A...
01:24Self-Inductance
Consider a circuit connected to an AC source. As the current varies with time, the magnetic flux through the circuit correspondingly changes. Faraday's law tells us that an emf would...
00:59Inductive Reasoning
Inductive reasoning is common in descriptive science. A life scientist makes observations and records them. This data can be qualitative or...