Variation in rapid sequence induction and intubation: a survey on current practice in the department of anaesthesiology at the University of the Witwatersrand
Redford, Lindsey Elizabeth
Background: Aspiration remains one of the major, preventable complications of general anaesthesia. Controversy regarding various aspects of RSII exists and there are no South African guidelines. The aim of this study was to describe the current practice of RSII by anaesthetists in the Department of Anaesthesiology at the University of the Witwatersrand. Method: A prospective, contextual, descriptive study was done. Questionnaires consisting of seven vignettes were distributed to survey current clinical practice. A 60.1% response rate was achieved. Results: There was considerable deviation from the original technique of RSII, with regard to induction agents, timing of NMBA administration and opioid use prior to induction. The induction agent and neuromuscular blocking agent (NMBA) of choice was propofol and succinylcholine. Succinylcholine was used for 83 (67.5%) of appendicectomies, 118 (96.7%) of Caesarean sections and 83 (68.0%) for bowel obstructions. Alternative NMBA were used for the other scenarios. The majority of the respondents, 97 (77.6%), considered the use of a NMBA other than succinylcholine to describe a modified RSII. No statistically significant variation in technique between senior and junior anaesthetists was evident, with the exception of the NMBA used for appendicectomies (p= 0.0017) and neonates (p=0.0297). Conclusion: Despite little variation in technique of RSII between consultant and trainee anaesthetists at Wits, their current practice shows marked variation from the technique originally described. This change in practice may be the result of advancement in knowledge, equipment, technique and available drugs. Furthermore, it is in keeping with international practice.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology, Johannesburg, 2016