There is a great heterogeneity in the practice of rapid sequence induction in the operating room in the world. There are no recent data assessing the rate of implementation of the latest French formalized expert recommendations in clinical practice. In addition, the modalities for the management of haemodynamic disorders, particularly hypotensive disorders, during rapid sequence induction are not described in these recommendations, although these are frequent events with a non-zero morbidity mortality potential. The goal of this prospective, observational, multicenter, anesthetic study is to describe the clinical practice of French anesthesiologists regarding the prevention of severe hemodynamic disorders during rapid sequence anesthetic induction in adult patients. The primary outcome measure is the occurrence of a major haemodynamic disorder defined by a MBP ≤ 50 mmHg (or ≤ 40% of the reference value) and/or ≥ 110 mmHg and/or the occurrence of sustained arrhythmia not present at induction and/or cardiac arrest within the first 10 minutes after induction of anesthesia. The clinical practices of pre-oxygenation, induction and intubation of French anesthesiologists and compliance with the formalized expert recommendations of 2017 and 2018 will also be studied secondarily. The elements for the prevention of gastric fluid inhalation, the organization and equipment used, the anesthetic and non-anesthetic drugs used, the clinical and paraclinical neurological and cardio-respiratory parameters and the nature of the complications following anaesthetic induction will be collected up to the 10th post-induction minute.
Study Type
OBSERVATIONAL
Enrollment
1,150
Rapid sequence induction and intubation (or crash induction) is a process for inducing general anesthesia when the patient is at a high risk of pulmonary aspiration. It aims at minimizing the time between giving the induction drugs and securing the tube, during which period the patient's airway is essentially unprotected.
Clinique Victor Pauchet
Amiens, France
RECRUITINGHospital
Arcachon, France
RECRUITINGHospital
Armentières, France
RECRUITINGHôpital Privé Arras les Bonnettes
Arras, France
Occurrence of a major haemodynamic disorder
MBP ≤ 50 mmHg (or ≤ 40% of the reference value) and/or ≥ 110 mmHg and/or occurrence of a sustained arrhythmia (\> 1 min) not present at induction and/or cardiac arrest
Time frame: Within the first 10 minutes after induction of anesthesia
Clinical pre-anesthesic assessment of the risk of a full stomach
\- percentage of clinical and/or imaging endpoints in favor of a full stomach
Time frame: From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure
Pre-anesthetic assessment of the risk of a full stomach
\- percentage of gastric ultrasound use
Time frame: From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure
Assessment of the risk of a full stomach
\- percentage of presence and use of the Nasogastric Tube
Time frame: From 6 hours before induction of anesthesia until the beginning of the preoxygenation for the rapid sequence induction procedure
Team involved in the rapid sequence induction technique
\- average number of individuals in the room participating in the performance of SRI
Time frame: Within the first 10 minutes after induction of anesthesia
Preparation for rapide sequence induction technique
\- Percentage of patients in supine position
Time frame: Within the first 10 minutes after induction of anesthesia
Use of morphine for rapid sequence induction technique
\- percentage of use of morphine derivative prior to airway securisation
Time frame: Within the first 10 minutes after induction of anesthesia
Induction therapeutics for rapid sequence induction technique
\- percentage of use of each of the following hypnotics: propofol, ketamine, thiopental, etomidate, midazolam, sevoflurane
Time frame: Within the first 10 minutes after induction of anesthesia
Use of curare for rapid sequence induction technique
\- percentage of use of a curare
Time frame: Within the first 10 minutes after induction of anesthesia
Use of vasopressive amine for rapid sequence induction technique
\- percentage and median dosage of vasopressive amine use for the prevention of low blood pressure
Time frame: Within the first 10 minutes after induction of anesthesia
Use of filling solution for rapid sequence induction technique
\- percentage and median volume of use of a preventive vascular filling solution
Time frame: Within the first 10 minutes after induction of anesthesia
Airway management for rapid sequence induction technique
\- type of preoxygenation
Time frame: Within the first 10 minutes after induction of anesthesia
Operator qualification for rapid sequence induction technique
\- percentages of first operator with a medical degree, of trained nurses, and of medical resident performing the rapid sequence induction technique
Time frame: Within the first 10 minutes after induction of anesthesia
Laryngoscopy for rapid sequence induction technique
\- percentage of use of a video laryngoscope as a 1st intention
Time frame: Within the first 10 minutes after induction of anesthesia
Medical device used for rapid sequence induction technique
\- percentage of mandrel use at the first laryngoscopy
Time frame: Within the first 10 minutes after induction of anesthesia
MBP complications of ISR (< 10 minutes)
\- percentage of episode of MBP ≤ at 50 mmHg (or ≤ 40% of the baseline)
Time frame: Within the first 10 minutes after induction of anesthesia
Tension complications of ISR (< 10 minutes)
\- percentage of episode of MBP ≥ 110 mmHg
Time frame: Within the first 10 minutes after induction of anesthesia
Rythmal complications of ISR (< 10 minutes)
\- sustained arrhythmia (\> 1 minute) not present at induction
Time frame: Within the first 10 minutes after induction of anesthesia
Cardiac complications of ISR (< 10 minutes)
\- cardiac arrest
Time frame: Within the first 10 minutes after induction of anesthesia
Intubation complications of ISR (< 10 minutes)
\- percentage of intubations that required more than one laryngoscopy
Time frame: Within the first 10 minutes after induction of anesthesia
Low tension-related complications of ISR (< 10 minutes)
\- percentage and median dosage of use of a vasopressive amine required for the treatment of low blood pressure (defined as a SBP \< 80 mmHg)
Time frame: Within the first 10 minutes after induction of anesthesia
High tension-related complications of ISR (< 10 minutes)
\- percentage of use of an antihypertensive drug or sedation-analgesia bolus for the treatment of high blood pressure (defined as SBP \> 160 mmHg)
Time frame: Within the first 10 minutes after induction of anesthesia
Respiratory complications of ISR (< 10 minutes)
\- percentage of respiratory complication defined by Spo2 \< 90% or the need for manual reventilation
Time frame: Within the first 10 minutes after induction of anesthesia
Anaphylactic complications of ISR (< 10 minutes)
\- percentage of Grade I, II, III or IV anaphylactic reaction
Time frame: Within the first 10 minutes after induction of anesthesia
Inhalation complications of ISR (< 10 minutes)
\- percentage of gastric fluid inhalation defined by the presence of non-salivary fluid or supraglottic solids during laryngoscopy
Time frame: Within the first 10 minutes after induction of anesthesia
Immediate complications of ISR (< 10 minutes)
\- percentage of intraoperative deaths
Time frame: Within the first 10 minutes after induction of anesthesia
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University Hospital
Brest, France
RECRUITINGUniversity Hospital
Caen, France
RECRUITINGCentre Hospitalier Intercommunal
Castres, France
RECRUITINGUniversity Hospital
Clermont-Ferrand, France
RECRUITINGCHD Vendée
La Roche-sur-Yon, France
RECRUITINGUniversity Hospital
Lille, France
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