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Published on: August 19, 2020
[RSI in pediatric anesthesia: an online survey of actual clinical practice]
Melanie Fieler1, Marcus Nemeth2, Vanessa Rigterink3
1Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. fieler.melanie@mh-hannover.de.
Insights
Pediatric anesthesia practices for rapid sequence induction (RSI) vary, with no fixed age limit for controlled RSI. Propofol is commonly used, even in neonates, and practices like video laryngoscopy use are inconsistent.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Patient Safety
Background:
For many years, controlled rapid sequence induction (cRSI) has been recommended in children at risk of aspiration to reduce the risk of hypoxia; however, no fixed age limit has been defined for the transition to classical RSI. This study examines the current practices of RSI in children as well as controversies regarding existing approvals, recommendations and clinical guidelines.
Methods:
An anonymous online survey was carried out among the members of the Scientific Working Group on Pedíatric Anesthesia (WAKKA) of the German Society of Anesthesiology and Intensive Care Medicine (DGAI).
Results:
A total of 244 questionnaires could be evaluated. Of the respondents 218 were specialists and 191 respondents performed pediatric anesthesia at least once a week. For 73.4%, there was no fixed age limit for cRSI. Despite off-label-use propofol is the most frequently used hypnotic agent also in the group of premature and newborn infants and rocuronium was the most used muscle relaxant in all age groups. Pressure-controlled ventilation until intubation is performed by 80% of the respondents. The standard use of a video laryngoscope for cRSI is confirmed by 34.8% of the respondents and relaxometry is used routinely by 59.8%.
Conclusion:
Controversial practices include the use of propofol in premature and newborn infants and the inconsistent use of video laryngoscopy, relaxometry, neuromuscular blocking agents, neuromuscular monitoring and mechanical pressure-controlled intermediate ventilation. The transition to classical RSI is based on individual patient circumstances regarding the risk of hypoxia. No fixed age limit could be identified.
