Guirro Ursula Bueno do Prado, Martins Cesar Romão, Munechika Masashi
Clinical Surgery, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
Rev Bras Anestesiol. 2012 May-Jun;62(3):335-45. doi: 10.1016/S0034-7094(12)70134-4.
The induction of the general anesthesia in patients on "a full stomach" can result in regurgitation of the gastric content and pulmonary aspiration. The function of the rapid sequence induction (RSI) is to minimize the time interval between the loss of the airway protection reflexes and tracheal intubation tube balloon. The objective of this study was to evaluate the rapid sequence induction among the anesthesiologists of the São Paulo Hospital.
The participants answered the questionnaire voluntarily and anonymously, after signed consent. The questionnaire consisted of 60 questions about the fundamental points of the RSI. The questions were divided in pre-oxygenation, circuits, drugs used in the induction (opioids, hypnotics, neuromuscular blockers), cricoid pressure techniques, intubation and difficult intubation.
Seventy-five questionnaires were applied and 22 were discarded due to incomplete answering. All anesthesiologists always declare doing pre-oxygenation and administering opioid, hypnotic, and neuromuscular blocker. Most use fentanyl (83%), propofol (74.5%) and succinylcoline (68.6%). All anesthesiologists apply cricoid pressure. Most did not know the correct pressure to be applied on the cricoid cartilage. Intubation failures have already occurred with 71.7% of anesthesiologists and with 40%, the regurgitation. When faced with an unexpected difficult intubation, anesthesiologists ask for the laryngeal mask (35.5%).
This study showed a broad individual variety of the RSI technique, a fact already reported by different authors. The difficulty in establishing a RSI protocol can be attributed to constant evidence that science provides us, where updating over the years becomes good medical practice.
对“饱胃”患者实施全身麻醉可导致胃内容物反流及肺误吸。快速顺序诱导（RSI）的作用是尽量缩短气道保护反射消失至气管插管套囊充气之间的时间间隔。本研究的目的是评估圣保罗医院麻醉医生对快速顺序诱导的应用情况。
参与者在签署知情同意书后自愿且匿名回答问卷。问卷包含60个关于快速顺序诱导基本要点的问题。问题分为预给氧、回路、诱导用药（阿片类药物、催眠药、神经肌肉阻滞剂）、环状软骨压迫技术、插管及困难插管。
共发放75份问卷，22份因回答不完整被剔除。所有麻醉医生均宣称总是进行预给氧并使用阿片类药物、催眠药和神经肌肉阻滞剂。大多数人使用芬太尼（83%）、丙泊酚（74.5%）和琥珀胆碱（68.6%）。所有麻醉医生均应用环状软骨压迫。大多数人不知道环状软骨应施加的正确压力。71.7%的麻醉医生曾发生插管失败，40%曾发生反流。面对意外的困难插管时，麻醉医生会要求使用喉罩（35.5%）。
本研究显示快速顺序诱导技术存在广泛的个体差异，这一事实已有不同作者报道。制定快速顺序诱导方案存在困难，这可归因于科学不断为我们提供新的证据，多年来不断更新已成为良好的医疗实践。
