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Br J Anaesth 2020 Jun 28. Epub 2020 Jun 28.

Dharan, Nepal. Electronic address:

Anaesthesia 2020 05;75(5):694

Hospices Civils de Lyon, Femme Mère Enfant Teaching Hospital, Lyon, France.

Anaesthesia 2020 May 12. Epub 2020 May 12.

Intensive Care Unit, Cabrini Hospital, Malvern, Vic, Australia.

The coronavirus disease 2019 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use during tracheal intubation. We evaluated the impact of two aerosol boxes (an early-generation box and a latest-generation box) on intubations in patients with severe coronavirus disease 2019 with an in-situ simulation crossover study. The simulated process complied with the Safe Airway Society coronavirus disease 2019 airway management guidelines. Read More

J Med Toxicol 2020 May 11. Epub 2020 May 11.

Lehigh Valley Health Network Department of Emergency and Hospital Medicine, Division of Medical Toxicology, USF Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown, PA, 18101, USA.

Introduction: Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated.

Discussion: A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Read More

Br J Anaesth 2020 07 27;125(1):e187-e188. Epub 2020 Apr 27.

Rome, Italy.

Int J Crit Illn Inj Sci 2020 Jan-Mar;10(1):20-24. Epub 2020 Mar 6.

Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.

Background: Rapid sequence induction and tracheal intubation through direct laryngoscopy (DL) has been the most common approach to secure the airway in trauma patients. The introduction of video laryngoscopy (VL) has changed airway management in many clinical settings. In this retrospective study, we assessed if immediate availability of VL in the trauma suite has changed the approach and outcomes of airway management during acute resuscitation at a dedicated trauma center. Read More

JAMA 2020 04;323(15):1507

Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University, Tuebingen, Germany.

JAMA 2020 04;323(15):1506-1507

Sydney Pharmacy School, University of Sydney, Sydney, Australia.

Br J Anaesth 2020 07 10;125(1):e28-e37. Epub 2020 Apr 10.

Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Electronic address:

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Read More

Rev Bras Anestesiol 2020 Jan - Feb;70(1):42-47. Epub 2020 Feb 19.

Universidade Federal de Alagoas, Maceió, AL, Brasil.

Introduction And Objectives: Magnesium sulfate has been used in anesthesia because it has relevant clinical features such as: analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults. Read More

Anesthesiology 2020 06;132(6):1317-1332

From the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (L.M., R.D.) the Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (H.Q.) the Department of Anesthesiology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China (L.W.) the Departments of Critical Care Medicine (Y.A., L.Z.) Anesthesiology (Q.G.) Respiratory Medicine (J.M.), Xiangya Hospital, Central South University, Changsha, Hunan Province, China the Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (Z.X.) the Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina (C.T.) the Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California (H.L.) the Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, Tongji University School of Medicine, Shanghai, China (L.X.).

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Read More

Int J Surg Case Rep 2020 15;68:203-207. Epub 2020 Feb 15.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

Introduction: Tracheal bronchus is a rare anomaly in which an accessory bronchial branch originates superior to the tracheal bifurcation. It is usually incidentally found in patients with recurrent chest infection, persistent stridor and less commonly due to foreign body aspiration.

Presentation Of Case: A 6-year-old medically and surgically free boy presented to the Emergency Department with severe shortness of breath. Read More

J Anaesthesiol Clin Pharmacol 2020 Jan-Mar;36(1):37-42. Epub 2020 Feb 18.

Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Background And Aims: Succinylcholine and high dose rocuronium are neuromuscular blocking agents commonly used for rapid sequence induction of anesthesia. Their usage is limited or contraindicated in some circumstances. The aim of this study is to determine the dosage and efficacy of atracurium without priming for rapid sequence induction of anesthesia. Read More

Australas Emerg Care 2020 Mar 12. Epub 2020 Mar 12.

Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Frauenfeld, Switzerland. Electronic address:

Background: Acceleromyometry is the clinical standard for quantitative neuromuscular monitoring, mostly using the stimulation pattern train-of-four (TOF). TOF-Cuff®, a recently introduced neuromuscular monitor with stimulating electrodes integrated within a blood pressure cuff, assesses the muscular response in the upper arm.

Methods: The time from administration of a neuromuscular blocking agent to TOF-ratio 0% during modified rapid sequence induction was compared between TOF-Cuff® and acceleromyometry (TOF-Scan®). Read More

BMC Anesthesiol 2020 Mar 2;20(1):54. Epub 2020 Mar 2.

Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.

Background: The evidence base for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0 mg kg) remains unclear.

Methods: We performed a systematic review and meta-analysis of randomized trials comparing any succinylcholine regimen with the standard regimen (1. Read More

Chin Med Sci J 2020 Feb 27. Epub 2020 Feb 27.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China.

Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Read More

Am Surg 2020 Jan;86(1):e22-e25

Acad Emerg Med 2020 02 20;27(2):100-108. Epub 2020 Jan 20.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.

Objective: The objective was to compare first-attempt intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning, and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department (ED) intubations.

Methods: This study was a secondary analysis of a multicenter prospective observational database of ED intubations from the National Emergency Airway Registry (NEAR). We compared all VL procedures to seven exploratory permutations of A-DL using multivariable regression models. Read More

Anaesth Crit Care Pain Med 2020 02 7;39(1):25-26. Epub 2020 Jan 7.

Service d'anesthésie et de réanimation, hôpital Saint-Louis, université de Paris, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.

Am J Respir Crit Care Med 2020 04;201(7):775-788

Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.

Tracheal intubation is commonly performed in critically ill patients. Unfortunately, this procedure also carries a high risk of complications; half of critically ill patients with difficult airways experience life-threatening complications. The high complication rates stem from difficulty with laryngoscopy and tube placement, consequences of physiologic derangement, and human factors, including failure to recognize and reluctance to manage the failed airway. Read More

JAMA 2019 12;322(23):2303-2312

Department of Emergency, CHU de la Réunion, Université de la Réunion, Réunion, France.

Importance: Rocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium.

Objective: To assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations. Read More

J Crit Care 2019 12;54:298-299

Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.

Resuscitation 2020 01 20;146:43-49. Epub 2019 Nov 20.

Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States. Electronic address:

Objective: Despite its important role in care of the critically ill, there have been few large-scale descriptions of the epidemiology of Emergency Medical Services (EMS) advanced airway management (AAM) and the variations in care with different patient subsets. We sought to characterize AAM performance in a national cohort of EMS agencies.

Methods: We used data from ESO Solutions, Inc. Read More

Anaesthesia 2020 03 30;75(3):313-322. Epub 2019 Oct 30.

Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Pulmonary aspiration of gastric content is a significant cause of anaesthesia-related morbidity and mortality. High-quality prospective randomised evidence to support prevention strategies, such as rapid sequence intubation, is difficult to generate due to well-described practical, ethical and methodological barriers. We aimed to generate an understanding of worldwide practice through surveying clinically practicing anaesthetists and airway experts. Read More

Anaesthesia 2020 03 30;75(3):298-300. Epub 2019 Oct 30.

Department of Anaesthesia, Guy's and St. Thomas' NHS Foundation Trust and Honorary Senior Lecturer, King's College, London, UK.

Acad Emerg Med 2020 04 24;27(4):347-348. Epub 2019 Nov 24.

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.

Acad Emerg Med 2020 04 24;27(4):346. Epub 2019 Nov 24.

Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan.

Anasthesiol Intensivmed Notfallmed Schmerzther 2019 Oct 22;54(10):617-628. Epub 2019 Oct 22.

Aspiration during anesthesia induction is no triviality, but can lead to serious complications and mortality. The classic technique of rapid sequence induction (RSI) is a fundamental form of anesthesia induction in non-fasting patients to prevent pulmonary aspiration of gastric contents.Pregnant women and children pose a special challenge due to their hypoxia risk; the classical RSI concept "induction - apnea - (cricoid pressure -) intubation" can lead to hypoxia and therefore must be modified in favor of a controlled technique with preservation of oxygenation in this patient group. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2019 Oct 22;54(10):604-615. Epub 2019 Oct 22.

The rapid sequence induction (RSI) is a not evidence-based technique designed to minimize the chance of pulmonary aspiration in high-risk patients requiring general anesthesia. Primary aim of this anesthetic technique is, therefore, a fast airway protection with an endotracheal tube to reduce the chance of passive or active regurgitation. This article discusses the anesthetic management of patients with an increased risk of aspiration, and, particularly, refers to the medications required for RSI. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2019 Oct 22;54(10):589-602. Epub 2019 Oct 22.

Rapid sequence induction and intubation (RSII) is the appropriate method of inducing general anaesthesia in patients who are at a risk of aspiration. The classical RSII is limited to a few treatment recommendations which are rarely based on evidence-based findings. New techniques (e. Read More

Lancet Respir Med 2019 12 1;7(12):997-999. Epub 2019 Oct 1.

Department of Emergency Care, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK. Electronic address:

Acta Anaesthesiol Scand 2020 01 10;64(1):41-47. Epub 2019 Oct 10.

Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland.

Purpose: To determine whether bag-mask ventilation between induction of anaesthesia and tracheal intubation in children with post-tonsillectomy bleeding reduces the incidence of hypoxaemia and difficult direct laryngoscopy without increasing perioperative respiratory complications.

Methods: Medical records, anaesthesia protocols and vital sign data were analysed from February 2005 to March 2017 for patients undergoing anaesthesia for surgical revision of bleeding tonsils. Type of rapid sequence induction and intubation (RSII; classical, ie, apnoeic, vs controlled, ie, with gentle bag-mask ventilation) was noted. Read More

BMC Res Notes 2019 Aug 28;12(1):546. Epub 2019 Aug 28.

Mekelle University, Mekelle, Tigray Region, Ethiopia.

Objective: The aim of this survey is to determine the standard of practice of cricoid pressure application on rapid sequence induction in Ayder comprehensive specialized hospital from April 3 to May 3, 2019.

Results: A total of 30 anesthetists were involved in the study with a response rate of 87%. Ninety percent of the respondents do not mask ventilate during rapid sequence induction and they do aspirate the naso-gastric tube if present. Read More

J Anesth 2019 Oct 21;33(5):600-603. Epub 2019 Aug 21.

Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya City, 343-8555, Saitama, Japan.

Purpose: Rocuronium Bromide Intravenous Solution® (Maruishi Pharmaceutical Co., Ltd, Osaka, Japan) is a newly developed generic drug and we have noticed that compared with conventional rocuronium formulations [e.g. Read More

West J Emerg Med 2019 Jul 3;20(4):610-618. Epub 2019 Jun 3.

University of Arizona College of Medicine, Department of Emergency Medicine, Tucson, Arizona.

Introduction: Airway management in the critically ill is associated with a high prevalence of failed first attempts and adverse events which negatively impacts patient care. The purpose of this investigation is to describe an airway continuous quality improvement (CQI) program and its effect on the safety of rapid sequence intubation (RSI) in the emergency department (ED) over a 10-year period.

Methods: An airway CQI program with an ongoing airway registry was initiated in our ED on July 1, 2007 (Academic Year 1) and continued through June 30, 2017 (Academic Year 10). Read More

Emerg Med J 2019 Jul 30;36(7):416-422. Epub 2019 May 30.

Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.

Introduction: Ambulance transport of patients with stroke is common, with rapid sequence intubation (RSI) to secure the airway used regularly. Randomised controlled trial evidence exists to support the use of RSI in traumatic brain injuries (TBIs), but it is not clear whether the RSI evidence from TBI can be applied to the patient with stroke. To this end, we analysed a retrospective stroke dataset to compare survival of patients with RSI compared with patients that did not receive RSI. Read More

Biomed Res Int 2019 17;2019:6791971. Epub 2019 Apr 17.

Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China.

The present study aims to investigate whether intravenous dexmedetomidine shows superiority to esmolol for hemodynamic response to tracheal intubation after rapid sequence induction. In the present meta-analysis, PubMed, EMBASE, and the Cochrane Library were searched for trials comparing dexmedetomidine with esmolol for the attenuation of the hemodynamic response to intubation. Ten trials were selected in the present meta-analysis. Read More

Am J Emerg Med 2020 03 6;38(3):466-470. Epub 2019 May 6.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.

Background: Previous work has suggested low rates of post-intubation sedation in patients undergoing endotracheal intubation (ETI) in the emergency department (ED) with limited data examining factors associated with sedation use. Utilizing a national database; we sought to determine the frequency of post-intubation sedation and associated factors.

Methods: We performed a retrospective analysis of a prospectively collected database (National Emergency Airway Registry (NEAR) from 25 EDs from January 1, 2016 to December 31, 2017). Read More

West J Emerg Med 2019 May 26;20(3):466-471. Epub 2019 Apr 26.

Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.

Endotracheal intubation (ETI) is a high-risk procedure commonly performed in emergency medicine, critical care, and the prehospital setting. Traditional rapid sequence intubation (RSI), the simultaneous administration of an induction agent and muscle relaxant, is more likely to harm patients who do not allow appropriate preparation and preoxygenation, have concerning airway anatomy, or severe hypoxia, acidemia, or hypotension. Ketamine, a dissociative anesthetic, can be used to facilitate two alternatives to RSI to augment airway safety in these scenarios: delayed sequence intubation - the use of ketamine to allow airway preparation and preoxygenation in the agitated patient; and ketamine-only breathing intubation, in which ketamine is used without a paralytic to facilitate ETI as the patient continues to breathe spontaneously. Read More

Air Med J 2019 May - Jun;38(3):161-164. Epub 2019 Feb 22.

Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, Bankstown Airport, New South Wales, Australia; Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands(3) Sydney Medical School, Sydney University.

Objective: Prehospital rapid sequence intubation (RSI) is prone to suboptimal documentation. The Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) uses a dedicated Airway Registry (AR) to aid documentation. The AR was only evaluated shortly after its introduction. Read More

Acad Emerg Med 2019 09 12;26(9):1108. Epub 2019 Jun 12.

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.

Acad Emerg Med 2019 09 11;26(9):1106-1107. Epub 2019 Jun 11.

Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.

Am J Emerg Med 2019 08 15;37(8):1588. Epub 2019 May 15.

Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Seattle Fire Department, Seattle, WA, USA.

Anesth Analg 2019 06;128(6):1256-1263

Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.

Background: In patients who undergo surgery for oropharyngeal masses, intubation is almost always successful. However, technical aspects of airway management, including bag mask ventilation and oxygenation, may still be difficult. Although rates of airway difficulty and intubation success in these patients have been studied, these data may not reflect difficulty with individual components of the intubation process. Read More

Scand J Trauma Resusc Emerg Med 2019 Apr 24;27(1):50. Epub 2019 Apr 24.

Department of Medical Education, California University of Science & Medicine, School of Medicine, 217 E Club Center Dr Suite A, San Bernardino, CA, 92408, USA.

Background: Existing difficult airway prediction tools are not practical for emergency intubation and do not incorporate physiological data. The HEAVEN criteria (Hypoxaemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguination, Neck mobility) may be more relevant for emergency rapid sequence intubation (RSI).

Methods: A retrospective analysis included air medical RSI patients. Read More

Br J Hosp Med (Lond) 2019 Apr;80(4):C58-C61

Specialist Registrar in Anaesthesia and Intensive Care, Department of Anaesthesia, University College Hospital NHS Foundation Trust, London.

Trials 2019 Apr 4;20(1):195. Epub 2019 Apr 4.

Emergency Medicine Department, National University Hospital, National University Health System, Level 4, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.

Background: Maintaining adequate oxygenation during rapid sequence intubation (RSI) is imperative to prevent peri-intubation adverse events that can lead to increased duration of hospital and intensive care unit stay, or a prolonged vegetative state requiring long-term institutionalisation. Despite employing current best practices during RSI, desaturation during intubation still occurs. High-flow nasal cannula (HFNC) oxygenation may potentially improve oxygenation during pre- and apnoeic oxygenation to allow a longer safe apnoeic time for RSI. Read More

Ann Emerg Med 2019 09 14;74(3):410-415. Epub 2019 Mar 14.

Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ.

Study Objective: Preoxygenation is important to prevent oxygen desaturation during emergency airway management. The purpose of this study is to describe the use of end tidal oxygen (eto) during rapid sequence intubation in the emergency department.

Methods: This study was carried out in 2 academic centers in Sydney, Australia, and New York City. Read More

Acta Anaesthesiol Scand 2019 07 12;63(6):837-838. Epub 2019 Mar 12.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center Chicago, Chicago, Illinois.

Acad Emerg Med 2019 09 19;26(9):1014-1021. Epub 2019 Mar 19.

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.

Background: The optimal order of drug administration (sedative first vs. neuromuscular blocking agent first) in rapid sequence intubation (RSI) is debated.

Objective: We sought to determine if RSI drug order was associated with the time elapsed from administration of the first RSI drug to the end of a successful first intubation attempt. Read More