"Crash induction" in patients with full stomach

Area of Science:

• Anesthesiology
• Gastroenterology

Background:

• "Crash induction" is a rapid anesthetic technique used in emergencies.
• Patients with a full stomach pose a risk of regurgitation during anesthesia induction.

Purpose of the Study:

• To review the rationale and safety of "crash induction" in patients with a full stomach.
• To identify risk factors and preventive measures for regurgitation during rapid sequence induction.

Main Methods:

• Review of existing literature on "crash induction" and gastroesophageal reflux.
• Analysis of patient factors influencing cardia competence and regurgitation risk.

Main Results:

• "Crash induction" is safe in patients with competent cardia if airway obstruction and intermittent positive pressure ventilation (IPPV) are avoided.
• Patients with incompetent cardia (e.g., intestinal obstruction, hiatus hernia) are at high risk of regurgitation.
• Esophageal accumulation of gastric contents can be suddenly released upon cricopharyngeal relaxation.

Conclusions:

• Adequate pre-operative stomach and esophageal decompression is crucial for high-risk patients.
• Backward cricoid pressure during induction is a necessary precautionary measure to prevent aspiration.