A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress.
BACKGROUND
Classic rapid-sequence induction of anaesthesia (RSI-classic) in infants and small children presents a time-critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI-controlled) that involves gentle mask ventilation until full non-depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI-controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress.


METHODS
In this controlled, randomized simulator-based study, 30 male trainees and specialists in anaesthesiology performed a simulated anaesthesia induction in a 4-week-old infant with pyloric stenosis. Two different RSI techniques, classic and controlled, were applied to 15 candidates each. We recorded the incidence of hypoxaemia, forced mask ventilation, and intubation difficulties. In addition, we measured individual stress levels by ergospirometry, salivary cortisol, and alpha-amylase, as well as a post-trial questionnaire.


RESULTS
Hypoxaemia always occurred in RSI-classic but not in RSI-controlled, repeatedly resulting in unsafe actions. Subjective stress perception and some objective stress levels were lower in the volunteers performing RSI-controlled.


CONCLUSIONS
Our data suggest that RSI-controlled, as compared with RSI-classic, leads to fewer unsafe actions and may reduce individual stress levels.
Eich
C
C
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre, Göttingen, Germany. ceich@med.uni-goettingen.de
Timmermann
A
A
Russo
S G
SG
Cremer
S
S
Nickut
A
A
Strack
M
M
Weiss
M
M
Müller
M P
MP
D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods*; D015415:Biomarkers; D002940:Circadian Rhythm; D002983:Clinical Competence; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D000860:Hypoxia / Q000517:prevention & control; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D008348:Manikins; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012044:Regression Analysis; D013147:Spirometry; D013312:Stress, Physiological
D015415:Biomarkers; D010100:Oxygen; D006854:Hydrocortisone