Gebremedhn Endale Gebreegziabher, Mesele Desta, Aemero Derso, Alemu Ehtemariam
Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia.
World J Emerg Med. 2014;5(4):279-85. doi: 10.5847/wjem.j.issn.1920-8642.2014.04.007.
Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.
An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.
A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%-64%, 65%-74%, 75%-84%, 85%-89 % and 90%-94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively.
The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.
快速顺序诱导插管（RSII）是一种用于有肺误吸风险患者的紧急气道管理技术。它包括预给氧、给予预定剂量的诱导和麻痹药物、避免面罩通气、喉镜检查，随后进行气管插管，并在气管导管套囊充气前持续施加环状软骨压迫。在RSII过程中已观察到氧饱和度下降。我们评估了RSII期间氧饱和度下降的发生率。
2014年3月3日至5月4日在我院进行了一项基于机构的观察性研究。纳入研究期间所有接受RSII全身麻醉手术的患者。准备了一份数据收集清单。
本研究共纳入153例患者，应答率为91.6%。分别有41例（26.8%）、50例（32.7%）、51例（33.3%）、38例（24.8%）和25例（16.3%）患者未准备好RSII的合适药物、RSII设备、困难插管设备、带导管的吸引器、监护仪和诸如复苏球囊等备用氧气。分别有17例（11.1%）患者未施加环状软骨压迫，53例（34.6%）患者在麻醉诱导后但在插管和气管导管套囊充气前进行了通气。共有55例（35.9%）患者在RSII期间出现氧饱和度下降（SPO2<95%）。最低、最高和平均氧饱和度下降分别为26%、94%和70.9%。氧饱和度下降范围在<50%、50%-64%、65%-74%、75%-84%、85%-89%和90%-94%的患者分别有6例（3.9%）、7例（4.6%）、5例（3.3%）、10例（6.5%）、13例（8.5%）和14例（9.2%）。
我院RSII期间氧饱和度下降的发生率较高。应强调术前患者优化和RSII技术培训。
