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Current practice of Rapid Sequence Induction (RSI) in pediatric anesthesia: A survey from India
Sana Yasmin Hussain1, Pratibha Panjiar1, Dhruv Jain2
1Department of Anesthesiology, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
Insights
Pediatric rapid sequence induction (RSI) practices vary widely. Less experienced anesthesiologists adhere more to RSI, and cricoid pressure use increases with child age, highlighting the need for standardized pediatric RSI protocols.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
Background:
- Rapid Sequence Induction (RSI) is a critical airway management technique for patients at risk of aspiration.
- Pediatric RSI practice exhibits significant variability due to patient-specific factors.
Purpose of the Study:
- To investigate current pediatric RSI practices and anesthesiologist adherence.
- To determine if practices differ based on anesthesiologist experience or patient age.
Main Methods:
- A survey was distributed to anesthesiologists at a pediatric national anesthesia conference.
- The questionnaire covered anesthesiologist experience, adherence, RSI conduct, and reasons for nonadherence.
Main Results:
- 75% response rate; less experienced anesthesiologists showed higher RSI adherence.
- Succinylcholine was the preferred induction agent, with use increasing in older children.
- Cricoid pressure application rose with age; experienced anesthesiologists used it more in infants (<1 year).
- Adherence to RSI in pediatric intestinal obstruction scenarios was lower than in adults.
Conclusions:
- Pediatric RSI practices show considerable variation and reasons for nonadherence differ from adult practices.
- Participants expressed a strong need for further research and standardized protocols for pediatric RSI.
Background And Aims:
Rapid Sequence Induction (RSI) is an established technique to secure the airway in patients who are at risk of aspiration. The practice of RSI in the pediatric population is highly variable due to numerous patient factors. We conducted a survey to find the prevalent practices and adherence of anesthesiologists to the practice of RSI in different pediatric age groups and whether it differs with the experience of the anesthesiologist or the age of the child.
Material And Methods:
The survey was conducted among residents and consultants attending the pediatric national anesthesia conference. The questionnaire consisted of 17 questions on anesthesiologist's experience, adherence, conduct of pediatric RSI, and the reason for nonadherence.
Results:
The response rate was 75% (192/256). Anesthetists having less than 10 years of experience adhered to RSI more often as compared to respondents with more experience. Succinylcholine was the most commonly used muscle relaxant for induction, with use increasing in higher age groups. The application of cricoid pressure increased with increasing age groups. Anesthetists with >10 years of experience used cricoid pressure more often in age groups of <1 year (P < 0.05). In a scenario of intestinal obstruction, adherence to RSI was low in pediatrics as compared to adults, with 82% of respondents agreeing to this.
Conclusion:
This survey on the practice of RSI in the pediatric population demonstrates wide variation in the practice among individuals and the reasons for nonadherence as compared to adults. It highlights the need felt by almost all the participants for more research and protocol in the practice of pediatric RSI.
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