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Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia
INTRODUCTION: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of deve...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391675/ https://www.ncbi.nlm.nih.gov/pubmed/25879683 http://dx.doi.org/10.1186/s13054-015-0872-2 |
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author | Lyon, Richard M Perkins, Zane B Chatterjee, Debamoy Lockey, David J Russell, Malcolm Q |
author_facet | Lyon, Richard M Perkins, Zane B Chatterjee, Debamoy Lockey, David J Russell, Malcolm Q |
author_sort | Lyon, Richard M |
collection | PubMed |
description | INTRODUCTION: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium. METHODS: We performed a comparative cohort study of major trauma patients undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using etomidate and suxamethonium and Group 2 underwent RSI using fentanyl, ketamine and rocuronium. Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality. RESULTS: Compared to Group 1 (n = 116), Group 2 RSI (n = 145) produced significantly better laryngoscopy views (p = 0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p = 0.007). A hypertensive response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p < 0.0001). A hypotensive response was uncommon in both groups (1% versus 6%; p = 0.05). Only one patient in each group developed true hypotension (SBP < 90 mmHg) on induction. CONCLUSIONS: In a comparative, cohort study, pre-hospital RSI using fentanyl, ketamine and rocuronium produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital trauma anaesthesia. |
format | Online Article Text |
id | pubmed-4391675 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43916752015-04-10 Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia Lyon, Richard M Perkins, Zane B Chatterjee, Debamoy Lockey, David J Russell, Malcolm Q Crit Care Research INTRODUCTION: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium. METHODS: We performed a comparative cohort study of major trauma patients undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using etomidate and suxamethonium and Group 2 underwent RSI using fentanyl, ketamine and rocuronium. Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality. RESULTS: Compared to Group 1 (n = 116), Group 2 RSI (n = 145) produced significantly better laryngoscopy views (p = 0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p = 0.007). A hypertensive response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p < 0.0001). A hypotensive response was uncommon in both groups (1% versus 6%; p = 0.05). Only one patient in each group developed true hypotension (SBP < 90 mmHg) on induction. CONCLUSIONS: In a comparative, cohort study, pre-hospital RSI using fentanyl, ketamine and rocuronium produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital trauma anaesthesia. BioMed Central 2015-04-01 2015 /pmc/articles/PMC4391675/ /pubmed/25879683 http://dx.doi.org/10.1186/s13054-015-0872-2 Text en © Lyon et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Lyon, Richard M Perkins, Zane B Chatterjee, Debamoy Lockey, David J Russell, Malcolm Q Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title | Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title_full | Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title_fullStr | Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title_full_unstemmed | Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title_short | Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
title_sort | significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391675/ https://www.ncbi.nlm.nih.gov/pubmed/25879683 http://dx.doi.org/10.1186/s13054-015-0872-2 |
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