Emerg Med J 2017 Aug 16. Epub 2017 Aug 16.

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

Objectives: The primary objective of this study was to determine the association between patient weight and first pass success (FPS) during rapid sequence intubation (RSI) in the ED. The secondary objective was to evaluate the association between patient weight and neuromuscular blocking agent (NMBA) dosing.

Methods: This was a retrospective cohort study conducted in a tertiary care academic ED. Read More

Acad Emerg Med 2017 Aug 9. Epub 2017 Aug 9.

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

Rapid sequence intubation (RSI) is the most common method of airway control in the emergency department (ED).(1,2) Administration of an anesthetic agent and a neuromuscular blocking agent (NMBA) optimizes conditions for tracheal intubation and is thought to minimize the risk of aspiration.(3-10) Evidence suggests that RSI improves first pass success and reduces complications in the critically ill. Read More

Eur J Anaesthesiol 2017 Sep;34(9):623-627

From the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Rostock (MS, IP, CH, GR, GN-S, TM); and Fraunhofer Institut for Cell Therapy and Immunology, Project Group EXIM, Rostock, Germany (MS, MM).

Background: The development of liver failure is a major problem in critically ill patients. The hepatotoxicity of many drugs, as one important reason for liver failure, is poorly screened for in human models. Rocuronium and succinylcholine are neuromuscular blocking agents used for tracheal intubation and for rapid-sequence induction. Read More

Crit Care 2017 Jul 31;21(1):192. Epub 2017 Jul 31.

Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.

Background: Pre-hospital endotracheal intubation is frequently used for trauma patients in many emergency medical systems. Despite a wide range of publications in the field, it is debated whether the intervention is associated with a favourable outcome, when compared to more conservative airway measures.

Methods: A systematic literature search was conducted to identify interventional and observational studies where the mortality rates of adult trauma patients undergoing pre-hospital endotracheal intubation were compared to those undergoing emergency department intubation. Read More

Indian J Crit Care Med 2017 Mar;21(3):146-153

Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. Read More

J Clin Anesth 2017 Feb 29;36:14-15. Epub 2016 Oct 29.

Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan.

BMC Res Notes 2017 Jan 3;10(1). Epub 2017 Jan 3.

Departments of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Background: Although airway management with neuromuscular blockade (NMB) alone is discouraged in the emergency department (ED), our previous study demonstrated that many patients were intubated using NMBs alone without sedatives. To refute this practice, we sought to compare the intubation success and adverse event rates between NMBs only and rapid sequence intubation (RSI).

Methods: This is a secondary analysis of the data from a prospective observational study of ED patients in 13 hospitals who underwent emergency airway management from April 2010 to August 2012. Read More

Anaesthesia 2017 Apr 30;72(4):439-443. Epub 2016 Dec 30.

Department of Otolaryngology - Head and Neck Surgery, University College Hospital NHS Foundation Trust, London, UK.

Pre-oxygenation is an essential part of rapid sequence induction of general anaesthesia for emergency surgery, in order to increase the oxygen reservoir in the lungs. We performed a randomised controlled trial of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) pre-oxygenation or facemask pre-oxygenation in patients undergoing emergency surgery. Twenty patients were allocated to each group. Read More

Indian J Anaesth 2016 Dec;60(12):922-930

Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. Read More

Indian J Anaesth 2016 Dec;60(12):899-905

Department of Paediatric Anaesthesia, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.

The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. Read More

Ann Emerg Med 2017 Jan;69(1):24-33.e2

Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address:

Study Objective: Induction doses of etomidate during rapid sequence intubation cause transient adrenal dysfunction, but its clinical significance on trauma patients is uncertain. Ketamine has emerged as an alternative for rapid sequence intubation induction. Among adult trauma patients intubated in the emergency department, we compare clinical outcomes among those induced with etomidate and ketamine. Read More

Eur J Emerg Med 2017 02;24(1):77

Departments of aTrauma Surgery bAnesthesiology cIntensive Care Medicine dHelicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, The Netherlands.

Eur J Emerg Med 2017 02;24(1):76-77

The Emergency Management Academy, Yonkers, New York, USA.

Acad Emerg Med 2017 Apr 24;24(4):411-421. Epub 2017 Mar 24.

Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Objective: We sought to describe and compare chart and video review as data collection sources for the study of emergency department (ED) rapid sequence intubation (RSI).

Methods: This retrospective cohort study compares the availability and content of key RSI outcome and process data from two sources: chart and video data from 12 months of pediatric ED RSI. Key outcomes included adverse effects (oxyhemoglobin desaturation, physiologic changes, inadequate paralysis, vomiting), process components (number of laryngoscopy attempts, end-tidal CO2 detection), and timing data (duration of preoxygenation and laryngoscopy attempts). Read More

World J Emerg Med 2016 ;7(4):285-289

Department of Anesthesia, Kitakyushu General Hospital, 5-10-10 Yugawa, Kokuraminami, Kitakyushu 800-0295, Japan.

Background: Pulmonary aspiration of gastric contents during tracheal intubation is a life-threatening complication in emergency patients. Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications. Although it has been considered that aspiration can be prevented in the lateral position, few studies have evaluated the ability to prevent aspiration. Read More

Anaesthesia 2017 Feb 30;72(2):156-171. Epub 2016 Nov 30.

Department of Anesthesiology and Director, Mother and Child Anesthesia Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel.

A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. Read More

Air Med J 2016 Nov - Dec;35(6):365-368. Epub 2016 Sep 21.

Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA.

Objective: This study sought to determine the effectiveness of apneic oxygenation in preventing hypoxemia during prehospital rapid sequence intubation (RSI).

Methods: We performed a case-cohort study using a pre-existing database looking at intubation management by a single helicopter emergency medical service between July 2013 and June 2015. Apneic oxygenation using high-flow nasal cannula (15 L/min) was introduced to the standard RSI protocol in July 2014. Read More

J Clin Anesth 2016 Dec 18;35:465-474. Epub 2016 Oct 18.

Department of Anesthesia, Division of Emergencies and Critical Care Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway. Electronic address:

Study Objective: Opioids are integral part of anesthesia induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during rapid-sequence induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. Read More

Saudi J Anaesth 2016 Oct-Dec;10(4):379-383

Department of Anesthesiology, ESIC Medical College and Hospital, Parippally, Kollam, Kerala, India.

Background: The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 × ED95) and 0.9 mg/kg (3 × ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Read More

Eur J Anaesthesiol 2016 Dec;33(12):943-948

From the Institute of Anaesthesiology, University and University Hospital Zurich (SS, DU, MS, MB, DRS, KR), Institute of Physiology, University Zurich, Zurich, Switzerland (MS), Department of Internal Medicine 2, Medical University Vienna, Vienna, Austria (GG), Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Switzerland (BS), and Department of Outcomes Research; Department of General Anaesthesiology, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (KR) *Simon Sulser and Dirk Ubmann contributed equally to the writing of this article.

Background: Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. Read More

Braz J Anesthesiol 2016 Nov - Dec;66(6):657-660. Epub 2016 Oct 1.

Centro de Ensino e Treinamento em Anestesiologia (CET-SBA) da Clínica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.

Background And Objectives: HELLP syndrome, characterized by hemolysis, high levels of liver enzyme, and low platelet count, is an advanced clinical stage of pre-eclampsia, progressing to high maternal (24%) and perinatal (up 40%) mortality, despite childbirth care in a timely manner. The goal is to describe the anesthetic management of a case with indication to emergency cesarean.

Case Report: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome. Read More

Rev Bras Anestesiol 2016 Nov - Dec;66(6):657-660. Epub 2014 Nov 27.

Centro de Ensino e Treinamento em Anestesiologia (CET-SBA) da Clínica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brasil.

Background And Objectives: HELLP syndrome, characterized by hemolysis, high levels of liver enzyme, and low platelet count, is an advanced clinical stage of pre-eclampsia, progressing to high maternal (24%) and perinatal (up 40%) mortality, despite childbirth care in a timely manner. The goal is to describe the anesthetic management of a case with indication to emergency caesarean.

Case Report: Female patient, 36 years old, gestational age of 24 weeks, with hypertensive crisis (BP 180/100 mmHg) and severe headache, was admitted to the operating room for a cesarean section after diagnosis of HELLP syndrome. Read More

Minerva Anestesiol 2016 Oct 6;82(10):1098-1106. Epub 2016 May 6.

AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France -

Acute respiratory failure is one the most common motives for intensive care unit admission. Although results from recent studies with high flow nasal oxygen have challenged our current management of these patients, a substantial number of them will require invasive mechanical ventilation and tracheal intubation. Life-threatening hypoxemia is the most frequent complication of these intubations. Read More

Am J Emerg Med 2016 Dec 28;34(12):2423-2425. Epub 2016 Sep 28.

Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC.

Objective: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients.

Methods: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011. Read More

J Clin Anesth 2016 Nov 3;34:312-3. Epub 2016 Jun 3.

Department of Anesthesiology, Osaka Medical College, Osaka, Japan.

World J Surg 2017 May;41(5):1184-1192

Trauma Unit, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4058, KwaZulu-Natal, South Africa.

Introduction: Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient .

Aim: To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing: premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence.

Method: A literature review of rapid sequence intubation in the trauma population was carried out, specifically comparison of the drugs used (induction agent, neuromuscular blocking drugs and adjuncts). Read More

J Emerg Med 2016 Oct 25;51(4):349-357. Epub 2016 Jul 25.

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

Background: Although the C-MAC (Karl Storz, Tuttlingen, Germany) is a video laryngoscope (VL), it can also be used as a direct laryngoscope (DL).

Objective: The goal of this study was to evaluate the utility of the C-MAC as a DL for intubations in the emergency department (ED).

Methods: This was an analysis of prospectively collected continuous quality-improvement data during the 6-year period from February 1, 2009 to January 31, 2015, when both the C-MAC and Macintosh DL (Mac DL) were clinically available in our ED. Read More

J Coll Physicians Surg Pak 2016 Jun;26(6):550

Department of Anaesthetics, St, Helens and Knowsley, NHS Trust, UK.

Braz J Anesthesiol 2016 Jul-Aug;66(4):418-22. Epub 2016 Apr 30.

Centro de Ensino e Treinamento da Sociedade Brasileira de Anestesiologia (CET/SBA), Cuiabá, MT, Brazil.

Background And Objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50kg/m(2), who underwent cesarean section under general anesthesia.

Case Report: Pregnant woman in labor, 35 years of age, body mass index 59. Read More

Am J Emerg Med 2016 Aug 28;34(8):1627-30. Epub 2016 May 28.

Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Republic of Korea. Electronic address:

Objectives: The objective of the study is to investigate the feasibility of noninvasive nasal positive pressure ventilation (NINPPV) for optimizing oxygenation during the rapid sequence intubation in critically ill patients.

Methods: A prospective, observational study was performed in an emergency department. Noninvasive nasal positive pressure ventilation was applied in the preoxygenation step and maintained until successful intubation. Read More

J Med Case Rep 2016 Jun 13;10(1):172. Epub 2016 Jun 13.

Department of Orthopedics Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.

Background: Penetrating neck injury is an important trauma subset but is relatively rare, especially when involving the posterior cervical column. Rupture of the neck restraints, including the interspinous and flavum ligaments, can create serious cervical instability that requires special consideration when managing the airway. However, no detailed information regarding airway management in patients with profound posterior neck muscle laceration and direct cervical ligament disruption by an edged weapon is yet available in the literature. Read More

Emerg Med Australas 2016 Jun 13;28(3):295-9. Epub 2016 Apr 13.

Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA.

Objective: The main objective of the present study was to examine the perceived versus actual time to intubation (TTI) as an indication to help determine the situational awareness of Emergency Physicians during rapid sequence intubation and, additionally, to determine the physician's perception of desaturation events.

Methods: A timed, observation prospective cohort study was conducted. A post-intubation survey was administered to the intubating physician. Read More

Masui 2016 Apr;65(4):384-6

We report the anesthetic management of a pediatric case of blue rubber bleb nevi syndrome combined with small-intestinal intussusception. A 2-year-old girl was transferred to our hospital for small-intestinal intussusception. Emergent ablation of the upper gastrointestinal tract nevus under general anesthesia was planned. Read More

J Clin Anesth 2016 Jun 22;31:46-52. Epub 2016 Mar 22.

Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Study Objective: To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts. Read More

Eur Rev Med Pharmacol Sci 2016 Apr;20(8):1479-89

Department of Anesthesiology and Intensive Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: The topic of drug administration sequence in rapid sequence induction (RSI) is still an object of interest in terms of rocuronium effectiveness. The aim of this prospective, randomized trial was to evaluate the effect of administration sequence of propofol and remifentanil on ED50 and ED95 of rocuronium in a RSI model.

Patients And Methods: Eighty-four patients were randomized into Group Remifentanil (Group R, n = 43), where induction of general anesthesia started with remifentanil (2 µg/kg) and followed by propofol (2 mg/kg) and rocuronium administrations; and Group Propofol (Group P, n = 41), where induction of general anesthesia started with propofol and followed by remifentanil and rocuronium. Read More

Indian J Anaesth 2016 Apr;60(4):258-63

Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India.

Background And Aims: Evidence and utility of the individual steps of the rapid sequence induction and tracheal intubation protocols have been debated, especially in the setting of traumatic brain injury. The purpose of this survey was to determine preferences in the current approach to rapid sequence intubation (RSI) in head injury patients among a population of anaesthesiologists from South India.

Methods: A questionnaire was E-mailed to all the members of the Indian Society of Anaesthesiologists' South Zone Chapter to ascertain their preferences, experience and comfort level with regard to their use of rapid sequence intubation techniques in adult patients with head injury. Read More

Br J Hosp Med (Lond) 2016 Apr;77(4):254

Consultant Anaesthetist in the Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London.

Eur J Emerg Med 2016 Apr 1. Epub 2016 Apr 1.

aDepartment of Anaesthesia, Pain and Critical Care, Western General Hospital bDepartment of Emergency Medicine, Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK.

Objectives: Tracheal intubation is the cornerstone of advanced emergency airway management in children and adults and there is good-quality data characterizing intubation in both groups. There are, however, few published studies on emergency tracheal intubation in adolescents. We carried out an observational study to characterize tracheal intubation in adolescents. Read More

Anesth Analg 2016 Jun;122(6):1901-6

From the Anesthesia Department of the University of Montreal Health Center, Université de Montréal, Montreal, Quebec, Canada.

Background: Endotracheal intubation is commonly performed via direct laryngoscopy (DL). However, in certain patients, DL may be difficult or impossible. The Bonfils Rigid Fiberscope® (BRF) is an alternative intubation device, the design of which raises the question of whether factors that predict difficult DL also predict difficult BRF. Read More

Masui 2016 Jan;65(1):42-9

Pulmonary aspiration of gastric or esophageal contents is uncommon; however, it is one of the most severe complications in the perioperative period. The aspiration is associated with possible clinical outcomes, ranging from mild asymptomatic limited episodes of bronchial injury up to the development of a severe acute respiratory distress syndrome. To reduce the incidence of pulmonary aspiration, rapid sequence induction and intubation and awake tracheal intubation are commonly chosen anesthetic techniques for the management of patients at risk of aspiration of gastric or esophageal contents. Read More

Am J Emerg Med 2016 Jun 26;34(6):953-6. Epub 2016 Jan 26.

Kartal Dr Lutfi Kırdar Training and Research Hospital EM Dept, Istanbul, Turkey. Electronic address:

Background: In this study we aimed to evaluate the success of ultrasonography (USG) for confirming the tube placement and timeliness by tracheal USG and ultrasonographic lung sliding in resuscitation and rapid sequence intubation.

Materials And Methods: This study was a prospective, single-center, observational study conducted in the emergency department of a tertiary care hospital. Patients were prospectively enrolled in the study. Read More

Anesth Analg 2016 May;122(5):1536-45

From the *Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; †Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; ‡2nd Anesthesiological Department, University Hospital Brno, Brno, Czech Republic; §Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; ‖Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; ¶Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; #Department of Obstetrics and Gynecology, University Hospital Olomouc, and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; and **Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.

Background: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. Read More

West J Emerg Med 2016 Mar 2;17(2):129-34. Epub 2016 Mar 2.

Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.

Introduction: The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED).

Methods: We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient's age, sex, principal indication for intubation, methods (e. Read More

Pregnancy Hypertens 2016 Jan 4;6(1):26-9. Epub 2016 Feb 4.

Gulhane Military Medical Academy, Department of Anesthesiology, Ankara, Turkey. Electronic address:

Objectives: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants.

Study Design: We designed a prospective, controlled, pilot single-center study. Read More

Ann Emerg Med 2016 May 26;67(5):610-615.e1. Epub 2016 Feb 26.

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

Study Objective: We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance.

Methods: Academic and community EDs in the United States, Canada, and Australia recorded data electronically, from 2002 to 2012, with verified greater than or equal to 90% reporting.

Results: Ten of 18 participating centers provided qualifying data, reporting 1,053 encounters. Read More

J Clin Anesth 2016 Mar 2;29:48-9. Epub 2016 Feb 2.

Department of Anesthesia, University Hospital of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.

Air Med J 2016 Jan-Feb;35(1):28-32

Greater Sydney Area Helicopter Emergency Medical Service, NSW Ambulance; Discipline of Emergency Medicine, Sydney University.

Objective: Prehospital rapid sequence intubation (RSI) of critically ill trauma patients is a high-risk procedure that may be associated with an increased rate of severe complications such as failed intubation, failure of oxygenation, hypoxia, hypotension, or need for surgical airway. The objective of this study was to describe the factors associated with difficult intubation in prehospital RSI as defined by more than a single look at laryngoscopy to achieve tracheal intubation.

Methods: This is an observational study using prospectively collected data. Read More

Acta Anaesthesiol Scand 2016 Jul 5;60(6):747-55. Epub 2016 Feb 5.

Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea.

Background: Current methods for verification of endotracheal intubation can fail, particularly in emergency settings. We investigated whether a verification method using electrical stimulation through electrodes placed on the endotracheal tube cuff could distinguish endotracheal and esophageal intubations in an experimental setting.

Methods: During three sequential sessions simulating emergency intubation without paralysis, rapid sequence intubation (RSI) with neuromuscular blockade, and intubation during cardiopulmonary resuscitation, eight pigs were intubated with an endotracheal tube fitted with two electrodes exposed on the cuff of the tube, first in the esophagus and next in the trachea or in reverse sequence. Read More

Intern Emerg Med 2016 Oct 4;11(7):983-92. Epub 2016 Feb 4.

University of Arizona College of Medicine, Tucson, AZ, USA.

Critically ill patients undergoing emergent intubation are at risk of oxygen desaturation during the management of their airway. Patients with intracranial hemorrhage (ICH) are particularly susceptible to the detrimental effects of hypoxemia. Apneic oxygenation (AP OX) may be able to reduce the occurrence of oxygen desaturation during the emergent intubation of these patients. Read More

Curr Opin Anaesthesiol 2016 Jun;29(3):261-7

Department of Anaesthesia, University Hospitals of Leicester, United Kingdom.

Purpose Of Review: Airway management and failed intubation in the pregnant woman requires unique considerations, which differ from the nonpregnant patient. Factors that influence airway management in this setting include anatomical and physiological changes in pregnancy, environmental factors as well as training matters. In addition, surgery is often being performed with extreme urgency, which requires rapid decision-making process that takes into account safe outcome of mother and baby. Read More