Classic and Modified Rapid Sequence Induction for Prevention of Gastric Content Regurgitation

Study Overview
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Brief Summary
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Induction of anesthesia induces a loss of protective upper airway reflexes and is associated with gastric content regurgitation. Emergency surgery bears a higher risk of gastric content regurgitation because of full stomach, delayed gastric emptying, intestinal obstruction, stroke or other factors. Rapid sequence induction (RSI) of anesthesia was recommended to minimize the risk of regurgitation and aspiration. Classic RSI scheme mainly includes the use of short-acting sedatives and muscle relaxant, together with a manual pressure to the cricoid cartilage (Sellick maneuver) which aims at compressing the esophagus to avoid regurgitation. Though widely recommended, the scheme has been controversial for years. Our department modified the scheme and put it into use in day shift emergency surgery since March 1, 2018. This retrospective analysis is aimed at comparing the effect of classic and modified rapid sequence induction in prevention of gastric content regurgitation in emergency surgery under general anesthesia.

Official Title
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Comparison of Classic and Modified Rapid Sequence Induction on Prevention of Perioperative Gastric Content Regurgitation in Emergency Surgery Under General Anesthesia

Conditions
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Rapid Sequence Induction

Intervention / Treatment
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* Procedure: Modified rapid sequence induction
* Procedure: Classic rapid sequence induction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients receive emergency surgery under general anesthesia March 1, 2015 to February 29, 2020 Eighteen years or older Exclusion Criteria: Trachea intubation status on admission Tracheotomy Bronchoscope surgery General anesthesia with laryngeal mask Awake intubation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group C<br>General anesthesia was induced with classic rapid sequence induction protocol. | Procedure: Classic rapid sequence induction<br>* In classic RSI scheme, patients are in supine position during induction and intubation. Sellick's technic is applied after sedatives and muscle relaxant are given.<br>|
| Group M<br>General anesthesia was induced with modified rapid sequence induction protocol. | Procedure: Modified rapid sequence induction<br>* Modified RSI was put into use in day shift emergency surgery since March 1, 2018. In this scheme, dorsal elevated position and apneic oxygenation technic are applied. Positive pressure mask ventilation is avoided unless necessary. Sellick's technic is not used in this scheme.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of gastric content regurgitation | The Electronic Anesthesia Record System files contained the word aspiration and/or gastric content were extracted and carefully evaluated. The events of gastric content regurgitation on admission or observed during tracheal intubation were recorded and analyzed. | From entering operation room to endotracheal intubation completed. |