RSI is more about the principle behind it than the precise technique used to achieve it. I’m assuming you won’t be surprised to see that my response to this is characteristically longwinded… This ignores ApOx which would suffice in these elective op kids and avoid bagging altogether. PIP limited breaths are fine in the peri-intubation. This is why Jim’s oxylator stuff is so cool as well. Key point is the PIP limitation on the breaths. Regarding atracurium, a fair alternative to succinylcholine, if faster-onset rocuronium isn’t available. Regarding cricoid pressure, what’s that? sounds dangerous. ideally this would be done using an NIV mask and a ventilator, which isn’t susceptible to operator catecholamine-induced overbagging, but a fair substitute for the sublime indifference of a machine is the phrase bag slowly and gently, slowly and gently. That said, this paper reminds us in patients with an oxygenation deficit, peri-induction ventilation is a strategy worth considering. The other half of the equation is quite important, however, and it is relevant, if one were to consider bringing a controlled RSII paradigm to the emergency department, that anesthesiologists probably spend 1000 minutes performing bag mask ventilation for every minute an emergency physician spends performing bag-mask ventilation. since kids desaturate faster than adults, the younger the patient, the more the balance tips to PIV. Peri-induction bag mask ventilation is appropriate when the likelihood of the patient developing clinically important hypoxia during the intubation attempt, if peri-induction ventilation is omitted, exceeds the likelihood of inducing vomiting and aspiration by doing bag mask ventilation. sevoflurane), by providers that have a different skillset. I can only speak for emergency department patients – this is an OR study, which is a different population, using a different set of tools (e.g. I encourage you to read the full paper if you can access it! I asked some FOAMEd colleagues to comment on the paper too so here are their thoughts! Seems reassuring! Also the incidence of serious hypoxia was very low (0.3%) This is in over a 1000 cases of their protocol. They report only one episode of regurgitation but no evidence of pulmonary aspiration. Now the interesting part is their complications profile. In many respects this is not RSI at all, not even a modified s simple induction of anaesthesia like any elective patient Strangely they chose in the main to use a slow acting paralytic, atracurium, rather than suxamethonium or rocuronium, justifying that the mask ventilation meant time was not crucial! They mostly chose to not use cricoid pressure, there was standard mask ventilation using pressure limit whilst paralysis onset awaited. Essentially a complete modification of the traditional RSI technique. They called it the ” controlled rapid sequence induction and intubation” protocol. This included emergency and elective cases. Its a retrospective audit of an anaesthesia protocol introduced in 2007 into a Swiss hospital for intubation of children who were at risk of aspiration ( unfasted or condition predisposing to gastric regurgitation. This interesting paper came up in my journal reading this month.Ĭontrolled rapid sequence induction and intubation : an analysis of 1001 children
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |