RSI in pediatric anesthesia - is it used by nonpediatric anesthetists? A survey from south-west England.
BACKGROUND
Rapid sequence induction (RSI) is the 'gold standard' technique for preventing aspiration of gastric contents during induction of anesthesia in unfasted patients. We conducted a survey to discover whether the conduct of RSI in children varies amongst anesthetists and if practice alters in relation to the time since training or degree of ongoing experience.


METHODS
Six hundred and fifteen questionnaires were sent to anesthetists in the south-west of England.


RESULTS
The response rate was 61%. Preoxygenation was utilized by 83% of anesthetists for infants whereas 94% preoxygenated schoolchildren, P < 0.001. Only 59% of respondents used cricoid pressure in infants, compared with 96% in schoolchildren, P < 0.001. Propofol was the induction agent of choice for all anesthetists, although thiopentone was used more in infants (35%) than schoolchildren (9%), P < 0.001. Suxamethonium was widely used in all children. All anesthetists intubated patients for pyloromyotomy, 50% using cricoid pressure. RSI was performed by 86% of anesthetists for appendicectomy, with consultants most likely to deviate from a standard RSI. Sixty percent of anesthetists intubated for manipulation of forearm, 72% performing an RSI, 53% intubated for scrotal exploration, but only 42% performed an RSI.


CONCLUSIONS
Classical RSI is used for children by most anesthetists in south-west England. RSI is modified for infants especially by more recently trained consultants. Suxamethonium is used less by consultant anesthetists. Whilst RSI is performed for appendicectomy there is a large variation in techniques for anesthetizing children for MUA and scrotal exploration which is independent of the grade of anesthetist.
Stedeford
Judith
J
Department of Anaesthesia, Bristol Children's Hospital, Bristol, UK. judithstedeford@hotmail.com
Stoddart
Peter
P
D000768:Anesthesia, General / Q000379:methods; D000776:Anesthesiology / Q000193:education; D016009:Chi-Square Distribution; D002648:Child; D003413:Cricoid Cartilage; D004739:England; D006801:Humans; D007223:Infant; D013511:Minor Surgical Procedures; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D010372:Pediatrics; D011312:Pressure / Q000009:adverse effects; D011364:Professional Practice / Q000706:statistics & numerical data; D053120:Respiratory Aspiration / Q000517:prevention & control; D013390:Succinylcholine / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013997:Time Factors
D013390:Succinylcholine