The influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation study

dc.contributor.authorSt. Pierre, Michael
dc.contributor.authorKrischke, Frederick
dc.contributor.authorLuetcke, Bjoern
dc.contributor.authorSchmidt, Joachim
dc.date.accessioned2019-03-20
dc.date.available2019-03-06
dc.date.created2019
dc.date.issued2019-03-20
dc.description.abstractBackground Aspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants’ airway management. Methods Eighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study. Anaesthesia was induced in reverse Trendelenburg position (+ 15°) in a manikin capable of dynamic fluid regurgitation. Participants were randomised to change to Trendelenburg position (− 15°) a) as soon as regurgitation was noticed, b) as soon as ‘patient’ had been anaesthetised, and c) as soon as ‘patient’ had been anaesthetised and with full cervical spine extension (Sellick). Primary endpoints were the aspirated volume and the time to intubation. Secondary endpoints were ratings of the laryngoscopic view and the intubation situation (0–100 mm). Results Combining head-down tilt with Sellick position significantly reduced aspiration (p < 0.005). Median time to intubate was longer in Sellick position (15 s [8–30]) as compared with the head in sniffing position (10 s [8–12.5]; p < 0.05). Participants found laryngoscopy more difficult in Sellick position (39.3 ± 27.9 mm) as compared with the sniffing position (23.1 ± 22.1 mm; p < 0.05). Both head-down tilt intubation situations were considered equally difficult: 34.8 ± 24.6 mm (Sniffing) vs. 44.2 ± 23.1 mm (Sellick; p = n.s). Conclusions In a simulated setting, using a manikin-based simulator capable of fluid regurgitation, a − 15° head-down tilt with Sellick position reduced the amount of aspirated fluid but increased the difficulty in visualising the vocal cords and prolonged the time taken to intubate. Assessing the airway management in the identical position in healthy patients without risk of aspiration might be a promising next step to take.en
dc.identifier.citationBMC Anesthesiology 19 (2019). <https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0686-x>
dc.identifier.doihttps://doi.org/10.1186/s12871-019-0686-x
dc.identifier.opus-id10661
dc.identifier.urihttps://open.fau.de/handle/openfau/10661
dc.identifier.urnurn:nbn:de:bvb:29-opus4-106611
dc.language.isoen
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/deed.de
dc.subjectAirway management
dc.subjectAspiration
dc.subjectRapid sequence induction
dc.subjectPatient safety
dc.subjectSimulation
dc.subject.ddcDDC Classification::6 Technik, Medizin, angewandte Wissenschaften :: 61 Medizin und Gesundheit :: 610 Medizin und Gesundheit
dc.titleThe influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation studyen
dc.typearticle
dcterms.publisherFriedrich-Alexander-Universität Erlangen-Nürnberg (FAU)
local.journal.titleBMC Anesthesiology
local.journal.volume19
local.sendToDnbfree*
local.subject.fakultaetMedizinische Fakultät
local.subject.sammlungUniversität Erlangen-Nürnberg / Von der FAU geförderte Open Access Artikel / Von der FAU geförderte Open Access Artikel 2018
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