Induction

2019 ◽  
pp. 101-118
Author(s):  
Nuria Masip ◽  
Barry Lambert
Keyword(s):  
Group Communication ◽  
Rapid Sequence Induction ◽  
Intravenous Route ◽  
Age Group ◽  
Anaesthetic Induction ◽  
Experienced Clinician ◽  
Induction Process ◽  
Advanced Airway ◽  
Rapid Sequence ◽  
Sequence Induction

Anaesthetic induction in children can be challenging even for the most experienced clinician. The anaesthetist’s approach must vary depending on the age group. Communication is paramount, since parents are frequently present at induction and are often stressed; the clinician must ensure the parent knows what is expected of them and what will happen at induction. Induction becomes even more challenging with the uncooperative child, and a well-thought-out plan is essential. Anaesthetic induction is performed either by an inhalational or an intravenous route; this chapter provides the reader with some simple top tips to provide a smooth induction process for child and parent. After induction, managing the airway is the priority; this chapter discusses both basic and advanced airway skills. In addition, the issue of administering a standard rapid sequence induction is discussed.

Hypotension following pre-hospital rapid sequence induction of anaesthesia: a retrospective database analysis

2017 ◽  
Vol 103 (2) ◽  
pp. 111-113
Author(s):  
RJ Howes ◽  
J Walsh ◽  
S Le Clerc ◽  
L Atkinson
Keyword(s):  
Rapid Sequence Induction ◽  
Anaesthetic Induction ◽  
Rapid Sequence ◽  
Potential Link ◽  
Sequence Induction ◽  
Group 3 ◽  
Group 2 ◽  
Induction Of Anaesthesia ◽  
Retrospective Database ◽  
Group 1

AbstractIntroductionRecent trends in Pre-Hospital Emergency Medicine (PHEM) have demonstrated the potential benefit of using fentanyl, ketamine and rocuronium for pre-hospital rapid sequence induction of anaesthesia (RSI). Isolated cases of potentially significant hypotension have been reported. This study aimed to establish a potential link between the incidence of hypotension and the dose and combination of anaesthetic induction agents used.MethodsA retrospective database review was undertaken of all cases attended by the Great North Air Ambulance Service requiring RSI during a 25-month period. The blood pressure (BP) before and after RSI and doses of drugs were recorded. Cases were divided into three groups based on changes in BP: group 1 (increase in BP post induction >20% or more), group 2 (between 20% increase and 20% fall in BP) and group 3 (fall in BP of 20% or more).Results105 cases were included in the analysis. Group 1 included 11 cases (range 23% to 106% increase in BP), group 2 included 57 cases (19% increase to 18% decrease) and group 3 included 37 cases (20% fall to 63% fall in BP).There was no statistically significant link to rocuronium (p=0.46) or ketamine (p=0.054) but the dose of fentanyl administered was highly significant (p<0.001).DiscussionThis review showed a potential link between fentanyl dose and the degree of hypotension during RSI. Although this is a small study with some limitations it gives an indication that dose ratios in RSI may need to be reviewed.

scholarly journals Introduction of a Rapid Sequence Induction Checklist and its effect on Compliance to Guidelines and Complications

2021 ◽  
Author(s):  
Jakob Zeuchner ◽  
Jonas Graf ◽  
Louise Elander ◽  
Jessica Frisk ◽  
Mats Fredrikson ◽  
...  
Keyword(s):  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Sequence Induction

scholarly journals Rapid sequence induction: where did the consensus go?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
James Raitt ◽  
Hans Morten Lossius ◽  
David Lockey
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Hospital Environment ◽  
Training Technique ◽  
Rapid Sequence ◽  
Gastric Aspiration ◽  
Sequence Induction ◽  
The Uk ◽  
Key Aspects ◽  
Risk Of Aspiration

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen

2020 ◽  
Author(s):  
Raphael Romano Bruno ◽  
Georg Wolff ◽  
Malte Kelm ◽  
Christian Jung
Keyword(s):  
Rapid Sequence Induction ◽  
High Flow ◽  
Ältere Personen ◽  
Rapid Sequence ◽  
Sind Eine ◽  
Sequence Induction ◽  
Thrombembolische Komplikationen ◽  
Invasive Beatmung

ZusammenfassungEtwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.

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