Good Hope Hospital, Sutton Coldfield, UK
Post Graduate Medical Institute, Anglia Ruskin University, Chelmsford, UK.
Br J Anaesth. 2016 Sep;117 Suppl 1:i69-i74. doi: 10.1093/bja/aew017. Epub 2016 Feb 24.
The 'classical' technique of rapid sequence induction (RSI) of anaesthesia was described in 1970. With the introduction of new drugs and equipment in recent years, a wide variation in this technique has been used. The role of cricoid pressure is controversial because of the lack of scientific evidence. Moreover, gentle mask ventilation has been recommended in situations such as obesity and critically ill patients, to prevent hypoxaemia during the apnoeic period. In identifying multiple techniques, we conducted a national postal survey to establish the current practice of RSI in the UK.
A survey consisting of 17 questions was created and posted to 255 National Health Service (NHS) hospitals in the UK. We included two copies of the questionnaire in each envelope; one to be completed by the airway lead (consultant anaesthetist with responsibility of overseeing the standard of airway training and implementing national airway guidelines and recommendations within their institution) and the other by a trainee in the same department. The difference in responses from consultants and trainees were assessed using the χ(2) test and the Fisher's exact test.
In total we received 272 responses (response rate 53%) of which 266 (58% from consultants and 42% from trainees) were analysed. A majority of the respondents (68%) pre-oxygenated by monitoring end-tidal oxygen concentration and 76% of the respondents use 20-25° head up tilt for all RSIs. Propofol is the most commonly used induction agent (64% of all respondents). Opioid has been used by 80% of respondents and only 18% of respondents use suxamethonium for all patients and others choose rocuronium or suxamethonium based on clinical situation. Although 92% of anaesthetists use cricoid pressure, 83% of them never objectively measure the force used. During the apnoeic period 17% of the respondents use gentle mask ventilation.
Our survey demonstrated a persistent variation in the practice of RSI amongst the anaesthetists in the UK. The 'classical' technique of RSI is now seldom used. Therefore there is a clear need for developing consistent guidelines for the practice of RSI.
快速序贯诱导麻醉（RSI）的“经典”技术于 1970 年被描述。近年来，随着新药物和设备的引入，这种技术的应用范围已经发生了很大的变化。由于缺乏科学证据，环状软骨施压的作用仍存在争议。此外，在肥胖和危重病患者等情况下，建议使用温和的面罩通气，以防止在呼吸暂停期间发生低氧血症。在确定多种技术时，我们进行了一项全国性的邮政调查，以确定英国 RSI 的当前实践。
创建了一个包含 17 个问题的调查，并将其邮寄到英国 255 家国民保健服务（NHS）医院。我们在每个信封中放入两份问卷；一份由气道负责人（负责监督气道培训标准并在其机构内实施国家气道指南和建议的顾问麻醉师）填写，另一份由同一部门的学员填写。使用卡方检验和 Fisher 精确检验评估顾问和学员的回答差异。
我们共收到 272 份回复（回复率为 53%），其中 266 份（顾问回复占 58%，学员回复占 42%）进行了分析。大多数受访者（68%）通过监测呼气末氧浓度进行预吸氧，76%的受访者对所有 RSI 采用 20-25°头高位。丙泊酚是最常用的诱导剂（占所有受访者的 64%）。阿片类药物已被 80%的受访者使用，只有 18%的受访者根据临床情况选择罗库溴铵或琥珀胆碱用于所有患者。尽管 92%的麻醉师使用环状软骨施压，但其中 83%的人从不客观测量使用的力。在呼吸暂停期间，17%的受访者使用温和的面罩通气。
我们的调查表明，英国麻醉师在 RSI 实践中存在持续的差异。RSI 的“经典”技术现在很少使用。因此，迫切需要制定 RSI 实践的一致指南。
