State of Rapid sequence induction in pediatric anesthetic practice in India: A survey

The use of rapid sequence induction (RSI) is a well-established method employed to effectively protect the airway in individuals who have a heightened susceptibility to aspiration. The procedural elements of "classical RSI" include many consecutive phases, which consist of preoxygenation, induction with thiopentone, application of cricoid pressure, administration of succinylcholine, avoidance of bag-mask ventilation, and quick tracheal intubation. The use of rapid sequence intubation (RSI) in the pediatric population exhibits significant variability as a result of many patient-related variables. The aforementioned circumstances have resulted in heterogeneity among pediatric anesthetists about the use of traditional rapid sequence induction (RSI), leading to the adoption of modified RSI (MRSI) as an alternative approach. The use of rapid sequence intubation (RSI) in the pediatric demographic exhibits significant variability as a result of many patient-related variables. A recent study was undertaken to investigate the prevailing practices and adherence of anesthesiologists to the practice of rapid sequence intubation (RSI) in various pediatric age cohorts, as well as to determine whether there are any variations based on the anesthesiologist's level of expertise or the age of the child.

Residents and consultants who attended the national pediatric anesthesia conference were surveyed. The survey had a total of 17 inquiries pertaining to the professional background, adherence to guidelines, execution of pediatric rapid sequence intubation (RSI), and the factors contributing to nonadherence among anesthesiologists.

The response rate achieved in the study was 75%, with 192 out of 256 participants providing a response. Respondents with fewer than 10 years of experience in the field of anesthesiology had a higher adherence rate to rapid sequence intubation (RSI) as compared to those with greater levels of expertise. Succinylcholine emerged as the prevailing muscle relaxant for the purpose of induction, with a notable rise in use across older age cohorts. The use of cricoid pressure shown an upward trend as the age groups rose. Anesthetists with more than ten years of experience shown a higher frequency of using cricoid pressure in age groups less than one year, with statistical significance (P < 0.05). In the context of intestinal obstruction, the level of adherence to Rapid Sequence Intubation (RSI) was shown to be comparatively lower in pediatric patients as compared to adults. This was supported by the agreement of 82% of the respondents.

The findings of this study pertaining to the implementation of Rapid Sequence Intubation (RSI) in the pediatric population reveal substantial heterogeneity in practice patterns among healthcare professionals, as well as the underlying causes contributing to noncompliance, in contrast to the adult population, despite the presence of perceived risk factors. The findings of this survey indicate a prevalent desire among the participants for more research and the implementation of protocol-based practices in the field of pediatric rapid sequence intubation (RSI). It is essential to provide comprehensive training to trainees in pediatric Rapid Sequence Intubation (RSI) to ensure their proficiency in executing all aspects of RSI with confidence.

Reference -

Hussain, Sana Yasmin; Panjiar, Pratibha; Jain, Dhruv1,; Khanooja, Samiksha; Batt, Kharat Mohammad. Current practice of Rapid Sequence Induction (RSI) in pediatric anesthesia: A survey from India. Journal of Anaesthesiology Clinical Pharmacology 39(1):p 88-97, Jan–Mar 2023. | DOI: 10.4103/joacp.joacp_172_21