A survey of paediatric rapid sequence induction in a department of anaesthesia

dc.contributor.authorDuncan, Lloyd
dc.date.accessioned2023-04-13T07:55:26Z
dc.date.available2023-04-13T07:55:26Z
dc.date.issued2022
dc.descriptionA research report submitted in the partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2022
dc.description.abstractBackground Rapid sequence induction (RSI) is carried out by anaesthetists to secure the airway promptly in patients who are at risk of aspirating gastric content during induction of anaesthesia. RSI requires variation in the paediatric population. We conducted a survey to investigate current practice of paediatric RSI by anaesthetists. Methods A descriptive, contextual, cross-sectional research design was followed. The study population consisted of all anaesthetists working in the Department of Anaesthesia at the University of the Witwatersrand. Data was collected in the form of a self-administered questionnaire. Results Of 138 questionnaires that were distributed, 126 were completed. Clinical indication for RSI was predominantly for appendicitis with peritonitis (115/124; 92.7%). Preoxygenation was performed by 95.1% of anaesthetists for children, 87% for infants and 89.4% for neonates. Cricoid pressure was used significantly more in children (56%) than in infants (20.8%) and neonates (10.3%) (p < 0.001). Rocuronium was the paralytic agent of choice in children (42.7%) and infants (38.2%) while cisatracurium was used most frequently in neonates (37.4%). Suxamethonium was used least in neonates. Cuffed ETTs were used most frequently for children (99.2%) and least for neonates (49.6%). Eighty-five percent of anaesthetists omitted cricoid pressure during RSI for pyloromytomy, for which a controlled RSI was performed more by consultants and senior registrars (p < 0.01). A classic RSI was performed by 53.6% of anaesthetists for laparotomy for small bowel obstruction. Consultants and PMOs were more likely to intubate a child for forearm MUA who was starved for 6 hours who and received opioids (p < 0.05). Controlled RSI with cisatracurium was the technique of choice for Tenkhoff insertion in a child with renal failure. Conclusion RSI practice for paediatric patients varied widely among anaesthetists. This may be attributed to a combination of anaesthetic experience, training in paediatric anaesthesia, and patient specific factors, along with the individualised clinical scenario’s aspiration risk. A controlled RSI technique appears to be implemented more frequently by anaesthetists with increased experience.
dc.description.librarianPC(2023)
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/34987
dc.language.isoen
dc.schoolSchool of Clinical Medicine
dc.titleA survey of paediatric rapid sequence induction in a department of anaesthesia
dc.typeDissertation
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
MMED L DUNCAN FIN-1.pdf
Size:
1.21 MB
Format:
Adobe Portable Document Format
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
2.43 KB
Format:
Item-specific license agreed upon to submission
Description:
Collections