Classic and Modified Rapid Sequence Induction for Prevention of Gastric Content Regurgitation

The First Affiliated Hospital with Nanjing Medical University8,601 enrolled

Overview

Induction of anesthesia induces a loss of protective upper airway reflexes and is associated with gastric content regurgitation. Emergency surgery bears a higher risk of gastric content regurgitation because of full stomach, delayed gastric emptying, intestinal obstruction, stroke or other factors. Rapid sequence induction (RSI) of anesthesia was recommended to minimize the risk of regurgitation and aspiration. Classic RSI scheme mainly includes the use of short-acting sedatives and muscle relaxant, together with a manual pressure to the cricoid cartilage (Sellick maneuver) which aims at compressing the esophagus to avoid regurgitation. Though widely recommended, the scheme has been controversial for years. Our department modified the scheme and put it into use in day shift emergency surgery since March 1, 2018. This retrospective analysis is aimed at comparing the effect of classic and modified rapid sequence induction in prevention of gastric content regurgitation in emergency surgery under general anesthesia.

Study Type

OBSERVATIONAL

Enrollment

8,601

Conditions

Rapid Sequence Induction

Interventions

Modified rapid sequence inductionPROCEDURE

Modified RSI was put into use in day shift emergency surgery since March 1, 2018. In this scheme, dorsal elevated position and apneic oxygenation technic are applied. Positive pressure mask ventilation is avoided unless necessary. Sellick's technic is not used in this scheme.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients receive emergency surgery under general anesthesia March 1, 2015 to February 29, 2020 * Eighteen years or older Exclusion Criteria: * Trachea intubation status on admission * Tracheotomy * Bronchoscope surgery * General anesthesia with laryngeal mask * Awake intubation

Outcomes

Primary Outcomes

Incidence of gastric content regurgitation

The Electronic Anesthesia Record System files contained the word "aspiration" and/or "gastric content" were extracted and carefully evaluated. The events of gastric content regurgitation on admission or observed during tracheal intubation were recorded and analyzed.

Time frame: From entering operation room to endotracheal intubation completed.