Current national recommendations on rapid sequence induction in Europe. How standardised is the 'standard of care'?

Abstract

When inducing general anaesthesia, protective reflexes of the airways diminish and finally fail – non-fasting or predisposed patients are then at risk of aspiration. Aspiration of gastric content can cause severe lung tissue damage, oxygenation disturbances and even acute respiratory distress syndrome, known after the first describer as Mendelson’s syndrome. Failure to secure the patients’ airway is a major contributor to an adverse outcome. Rapid sequence induction (RSI) is generally accepted as the technique of choice for securing the airway in patients at risk for aspiration. Such risks include conditions that predispose (e.g. gastroesophageal reflux disease), are illness-specific (e.g. ileus) or situational (e.g. non-fasting patient in an emergency). Although the concept of RSI is generally approved, the technique itself is not standardised at all. Many drugs may be used and are recommended in literature, including any combination of different hypnotics, opioids and muscle relaxants. Furthermore, several different techniques can be used, such as cricoid pressure, head-up or head-down position, extensive oxygenation prior to inductionof anaesthesia or semi-rigid stylets in the tracheal tube. In Germany, the scientific working group ‘paediatric anaesthesia’, a subgroup of specialists from the German Society of Anaesthesiology and Intensive Care (DGAI), has published a detailed recommendation on RSI for children. However, for adult patients, no recommendations have been published in our country. The aim of our study was to evaluate the situation of current recommendations for RSI in all European countries.