Complications during rapid sequence induction of general anesthesia in children

A benchmark study

Frank J. Gencorelli, Ryan G. Fields, Ronald S. Litman

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objectives: Determine incidence of complications such as difficult or failed intubation, hypoxemia, hypotension, and bradycardia in children undergoing rapid sequence intubation (RSI) in a pediatric anesthesia department in a tertiary care children's hospital. Aim: To establish a benchmark to be used by other institutions and nonanesthesiologists performing RSI in children. Background: RSI is being increasingly performed in the nonoperating room setting by nonanesthesiologists. No published studies exist to establish a benchmark of intubation success or failure and complications in this patient population. Methods/Materials: Retrospective cohort analysis of children aged 3-12 undergoing RSI from 2001 to 2006. Results: One thousand seventy children underwent RSI from 2001 to 2006. Twenty (1.9%) developed moderate hypoxemia (SpO2 80-89%), 18 (1.7%) demonstrated severe hypoxemia (SpO 2 < 80%), 5 (0.5%) developed bradycardia (heart rate <60), and 8 (0.8%) developed hypotension (systolic blood pressure <70 mmHg). One patient had emesis of gastric contents but no evidence of pulmonary aspiration or hypoxemia. Eighteen (1.7%) children were noted to be difficult to intubate and required more than one intubation attempt. All were eventually intubated without significant complications. Patients between 10 and 19 kg had a higher incidence of severe hypoxemia when compared with older children (P < 0.001). There was no association between choice of muscle relaxant and any complication. Conclusions: In our cohort of 1070 children who underwent RSI, difficult intubation was encountered in 1.7% and transient oxyhemoglobin desaturation occurred in 3.6%. Severe hypoxemia was more likely in children <20 kg. There were no children who could not be intubated, and there were no long-term or permanent complications.

Original languageEnglish (US)
Pages (from-to)421-424
Number of pages4
JournalPaediatric Anaesthesia
Volume20
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

Fingerprint

Benchmarking
Intubation
General Anesthesia
Bradycardia
Hypotension
Hospital Anesthesia Department
Blood Pressure
Oxyhemoglobins
Gastrointestinal Contents
Incidence
Tertiary Healthcare
Vomiting
Hypoxia
Cohort Studies
Heart Rate
Pediatrics

Keywords

  • Complications
  • Pediatric anesthesia
  • Rapid sequence intubation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Complications during rapid sequence induction of general anesthesia in children : A benchmark study. / Gencorelli, Frank J.; Fields, Ryan G.; Litman, Ronald S.

In: Paediatric Anaesthesia, Vol. 20, No. 5, 05.2010, p. 421-424.

Research output: Contribution to journalArticle

Gencorelli, Frank J. ; Fields, Ryan G. ; Litman, Ronald S. / Complications during rapid sequence induction of general anesthesia in children : A benchmark study. In: Paediatric Anaesthesia. 2010 ; Vol. 20, No. 5. pp. 421-424.
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abstract = "Objectives: Determine incidence of complications such as difficult or failed intubation, hypoxemia, hypotension, and bradycardia in children undergoing rapid sequence intubation (RSI) in a pediatric anesthesia department in a tertiary care children's hospital. Aim: To establish a benchmark to be used by other institutions and nonanesthesiologists performing RSI in children. Background: RSI is being increasingly performed in the nonoperating room setting by nonanesthesiologists. No published studies exist to establish a benchmark of intubation success or failure and complications in this patient population. Methods/Materials: Retrospective cohort analysis of children aged 3-12 undergoing RSI from 2001 to 2006. Results: One thousand seventy children underwent RSI from 2001 to 2006. Twenty (1.9{\%}) developed moderate hypoxemia (SpO2 80-89{\%}), 18 (1.7{\%}) demonstrated severe hypoxemia (SpO 2 < 80{\%}), 5 (0.5{\%}) developed bradycardia (heart rate <60), and 8 (0.8{\%}) developed hypotension (systolic blood pressure <70 mmHg). One patient had emesis of gastric contents but no evidence of pulmonary aspiration or hypoxemia. Eighteen (1.7{\%}) children were noted to be difficult to intubate and required more than one intubation attempt. All were eventually intubated without significant complications. Patients between 10 and 19 kg had a higher incidence of severe hypoxemia when compared with older children (P < 0.001). There was no association between choice of muscle relaxant and any complication. Conclusions: In our cohort of 1070 children who underwent RSI, difficult intubation was encountered in 1.7{\%} and transient oxyhemoglobin desaturation occurred in 3.6{\%}. Severe hypoxemia was more likely in children <20 kg. There were no children who could not be intubated, and there were no long-term or permanent complications.",
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