Rapid Sequence Induction

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Jonsson M Fagerlund - One of the best experts on this subject based on the ideXlab platform.

  • pre oxygenation using high flow nasal oxygen vs tight facemask during Rapid Sequence Induction
    Anaesthesia, 2021
    Co-Authors: A Sjoblom, J Broms, M Hedberg, A Lodenius, A Furubacke, R Henningsson, A Wiklund, Sabine Nabecker, L Theiler, Jonsson M Fagerlund
    Abstract:

    Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during Rapid Sequence Induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for Rapid Sequence Induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where Rapid Sequence Induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for Rapid Sequence Induction.

  • transnasal humidified Rapid insufflation ventilatory exchange thrive vs facemask breathing pre oxygenation for Rapid Sequence Induction in adults a prospective randomised non blinded clinical trial
    Anaesthesia, 2018
    Co-Authors: A Lodenius, Jonsson M Fagerlund, J Piehl, A Ostlund, J Ullman
    Abstract:

    Transnasal humidified Rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in Rapid Sequence Induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing Rapid Sequence Induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE. Median (IQR [range]) lowest SpO2 until 1 min after intubation was 99% (97-100 [70-100]%) for the facemask group vs. 99% (99-100 [96-100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre-oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34-66 [22-261]) s in the facemask group vs. 48 (38-63 [10-146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86-142 [37-291]) s and 116 (92-146 [63-249]) s when using facemask and THRIVE, respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for Rapid Sequence Induction compared with facemask pre-oxygenation.

A Lodenius - One of the best experts on this subject based on the ideXlab platform.

  • pre oxygenation using high flow nasal oxygen vs tight facemask during Rapid Sequence Induction
    Anaesthesia, 2021
    Co-Authors: A Sjoblom, J Broms, M Hedberg, A Lodenius, A Furubacke, R Henningsson, A Wiklund, Sabine Nabecker, L Theiler, Jonsson M Fagerlund
    Abstract:

    Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during Rapid Sequence Induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for Rapid Sequence Induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where Rapid Sequence Induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for Rapid Sequence Induction.

  • transnasal humidified Rapid insufflation ventilatory exchange thrive vs facemask breathing pre oxygenation for Rapid Sequence Induction in adults a prospective randomised non blinded clinical trial
    Anaesthesia, 2018
    Co-Authors: A Lodenius, Jonsson M Fagerlund, J Piehl, A Ostlund, J Ullman
    Abstract:

    Transnasal humidified Rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in Rapid Sequence Induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing Rapid Sequence Induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE. Median (IQR [range]) lowest SpO2 until 1 min after intubation was 99% (97-100 [70-100]%) for the facemask group vs. 99% (99-100 [96-100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre-oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34-66 [22-261]) s in the facemask group vs. 48 (38-63 [10-146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86-142 [37-291]) s and 116 (92-146 [63-249]) s when using facemask and THRIVE, respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for Rapid Sequence Induction compared with facemask pre-oxygenation.

Tom Heier - One of the best experts on this subject based on the ideXlab platform.

  • dose requirements of alfentanil to eliminate autonomic responses during Rapid Sequence Induction with thiopental 4 mg kg and rocuronium 0 6 mg kg
    Journal of Clinical Anesthesia, 2016
    Co-Authors: Mohammad H Abouarab, Morten Rostrup, Tom Heier
    Abstract:

    Abstract Study objective Opioids are integral part of anesthesia Induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during Rapid-Sequence Induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. Design Prospective, randomized, observer-blinded, interventional clinical study. Setting Large academic institution. Patients Eighty-four healthy patients, aged 18 to 55 years, received 1 of 7 assessor-blinded doses of alfentanil (0, 10, 20, 30, 40, 50, and 60 μg/kg) together with thiopental 4 mg/kg and rocuronium 0.6 mg/kg, administered in Rapid succession (15 seconds). Laryngoscopy was initiated 40 seconds after rocuronium, and tracheal intubation was concluded within 15 seconds thereafter. Measurements An indwelling radial artery catheter was used for hemodynamic monitoring and blood sampling. Relationships between alfentanil dose and response variables were tested with linear regression, and the influence of covariates (sex, body weight, and age) was determined. Alfentanil dose needed to prevent increases in ABP >10% above baseline with 95% probability was estimated with logistic regression. Main results Significant relationships were determined between alfentanil dose and response variables. Clinically interesting influence of covariates was not found. Alfentanil 55 μg/kg was needed to prevent increases in ABP postintubation >10% above baseline with 95% probability. One individual needed a bolus of vasopressor postintubation. Conclusions Optimal control of autonomic responses during Rapid-Sequence Induction was achieved with clinically relevant doses of alfentanil in healthy patients anesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg.

  • alfentanil during Rapid Sequence Induction with thiopental 4 mg kg and rocuronium 0 6 mg kg tracheal intubation conditions
    Acta Anaesthesiologica Scandinavica, 2015
    Co-Authors: M H Abouarab, John Feiner, Olav Spigset, Tom Heier
    Abstract:

    Background Opioids have become an integral part of anaesthesia Induction. We aimed to determine the dose of alfentanil needed to obtain perfect tracheal intubation conditions during Rapid Sequence Induction with standard doses of thiopental and rocuronium, where laryngoscopy was initiated 55 s after commencement of drug administration. The influence of covariates (sex, body weight, age, alfentanil plasma concentration at laryngoscopy) was tested. Methods Eighty-four healthy individuals were randomly assigned to receive one of the seven assessor-blinded alfentanil doses (0, 10, 20, 30, 40, 50 and 60 μg/kg) in conjunction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. For drug administration, 15 s was allowed. Laryngoscopy was initiated 40 s after rocuronium and tracheal intubation concluded within 70 s after commencement of drug administration. Alfentanil doses associated with 50%, 90% and 95% probability of perfect intubation conditions were determined with logistic regression. Multiple logistic regressions were used to test the influence of covariates. The relationship between alfentanil dose and concentration at laryngoscopy was analysed with linear regression. The effects of covariates on plasma concentrations of alfentanil were tested with multiple linear regressions. Results Perfect intubation conditions of 95% probability was obtained with 56 μg/kg (confidence intervals 44–68). None of the covariates were significant predictors of perfect intubation conditions. Alfentanil plasma concentration correlated with dose and increased with increasing body weight (1.7 ng/ml/kg). Conclusion Perfect intubation conditions during Rapid Sequence Induction can be obtained with clinically relevant doses of alfentanil in most healthy patients anaesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg.

  • dose of alfentanil needed to obtain optimal intubation conditions during Rapid Sequence Induction of anaesthesia with thiopentone and rocuronium
    BJA: British Journal of Anaesthesia, 2007
    Co-Authors: M H Abouarab, Tom Heier, James E Caldwell
    Abstract:

    Background The primary aim of the present study was to determine the dose of alfentanil that must be added to a Rapid-Sequence Induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals. Methods A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 µg kg−1). A blinded dose of alfentanil followed by thiopentone 4 mg kg−1 and rocuronium 1 mg kg −1 was administered in Rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter. Results The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4–39.4) μg kg−1. In 12 patients, the systolic BP declined to Conclusion Adding 36–40 µg kg−1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.

S A R Nouraei - One of the best experts on this subject based on the ideXlab platform.

  • a randomised controlled trial comparing transnasal humidified Rapid insufflation ventilatory exchange thrive pre oxygenation with facemask pre oxygenation in patients undergoing Rapid Sequence Induction of anaesthesia
    Anaesthesia, 2017
    Co-Authors: F Mir, Anil Kumar Patel, R Iqbal, M Cecconi, S A R Nouraei
    Abstract:

    Pre-oxygenation is an essential part of Rapid Sequence Induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified Rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. No patient developed arterial oxygen saturation < 90% during attempted tracheal intubation. Arterial blood gases were sampled from an arterial catheter immediately after intubation. The mean (SD) PaO2 was 43.7 (15.2) kPa in the THRIVE group vs. 41.9 (16.2) kPa in the facemask group (p = 0.722); PaCO2 was 5.8 (1.1) kPa in the THRIVE group vs. 5.6 (1.0) kPa in the facemask group (p = 0.631); arterial pH was 7.36 (0.05) in the THRIVE group vs. 7.34 (0.06) in the facemask group (p = 0.447). No airway rescue manoeuvres were needed, and there were no differences in the number of laryngoscopy attempts between the groups. In spite of this, patients in the THRIVE group had a significantly longer apnoea time of 248 (71) s compared with 123 (55) s in the facemask group (p < 0.001). Transnasal humidified Rapid insufflation ventilatory exchange is a practicable method for pre-oxygenating patients during Rapid Sequence Induction of general anaesthesia for emergency surgery; we found that it maintained an equivalent blood gas profile to facemask pre-oxygenation, in spite of a significantly longer apnoea time.

A Ostlund - One of the best experts on this subject based on the ideXlab platform.

  • transnasal humidified Rapid insufflation ventilatory exchange thrive vs facemask breathing pre oxygenation for Rapid Sequence Induction in adults a prospective randomised non blinded clinical trial
    Anaesthesia, 2018
    Co-Authors: A Lodenius, Jonsson M Fagerlund, J Piehl, A Ostlund, J Ullman
    Abstract:

    Transnasal humidified Rapid-insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre-oxygenation in Rapid Sequence Induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2 ) during intubation when pre-oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing Rapid Sequence Induction of anaesthesia for emergency surgery, were randomly allocated to pre-oxygenation with 100% oxygen with facemask or with THRIVE. Median (IQR [range]) lowest SpO2 until 1 min after intubation was 99% (97-100 [70-100]%) for the facemask group vs. 99% (99-100 [96-100]%) for the THRIVE group (p = 0.097). Five patients (12.5%) desaturated below 93% when pre-oxygenated with the facemask vs. none in the THRIVE group (p = 0.019). There were no differences in intubation time or apnoea time between the groups. Median intubation time was 51 (34-66 [22-261]) s in the facemask group vs. 48 (38-63 [10-146]) s in the THRIVE group (p = 0.99). Median apnoea time was 109 (86-142 [37-291]) s and 116 (92-146 [63-249]) s when using facemask and THRIVE, respectively (p = 0.49). No signs of regurgitation of gastric content were detected. The data on desaturation indicate potential benefits of oxygenation with THRIVE for Rapid Sequence Induction compared with facemask pre-oxygenation.