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Anesth Analg 2021 Jun 1. Epub 2021 Jun 1.

From the Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center.

Background: Cricoid pressure has been used as a component of the rapid sequence induction and intubation technique. However, concerns have been raised regarding the effectiveness and safety of cricoid pressure. Paratracheal pressure, a potential alternative to cricoid pressure to prevent regurgitation of gastric contents or aspiration, has been studied to be more effective to cricoid pressure in preventing gastric insufflation during positive pressure ventilation. Read More

Scand J Trauma Resusc Emerg Med 2021 May 13;29(1):64. Epub 2021 May 13.

Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.

Background: Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Read More

Anesthesiology 2021 Apr 13. Epub 2021 Apr 13.

Background: Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Read More

Trials 2021 Mar 30;22(1):237. Epub 2021 Mar 30.

Université de Nantes, CHU Nantes, Pôle Anesthésie-Réanimation, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Nantes, F-44093, France.

Background: Rapid-onset paralytic agents are recommended to achieve muscle relaxation and facilitate tracheal intubation during rapid sequence induction in patients at risk of pulmonary aspiration of gastric contents. However, opioids are frequently used in this setting. The study's objective is to demonstrate the non-inferiority of remifentanil compared to rapid-onset paralytic agents, in association with an hypnotic drug, for tracheal intubation in patients undergoing  procedure under general anesthesia and at risk of pulmonary aspiration of gastric contents. Read More

Anaesth Crit Care Pain Med 2021 Apr 4;40(2):100817. Epub 2021 Mar 4.

Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France. Electronic address:

Background: The objective of this study was to measure the incidence of arterial oxygen desaturation during rapid sequence induction intubation in children following apnoeic oxygenation via transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).

Methods: In this prospective observational study, arterial desaturation < 95% SaO before intubation was recorded following apnoeic RSI combining an intravenous hypnotic agent, suxamethonium and THRIVE (used during the apnoeic period). The incidence of desaturation was calculated in the whole cohort and according to patients' age (older or younger than 1 year). Read More

Anaesthesia 2021 Feb 18. Epub 2021 Feb 18.

Peri-operative Medicine and Intensive Care, Karolinska University Hospital Solna, Solna, Sweden.

Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. Read More

Prehosp Emerg Care 2021 Mar 16:1-11. Epub 2021 Mar 16.

The objectives of this study were to evaluate first attempt intubation failure rate, its associated factors, and its related complications in out-of-hospital emergency setting, when emergency physicians perform standardized airway management using rapid sequence intubation in adult patients. : The present study was a substudy of the Succinylcholine versus Rocuronium for out-of-hospital Emergency Intubation (CURASMUR) Trial, which compared Succinylcholine and Rocuronium used for Rapid sequence intubation. First attempt Intubation failure rate and early intubation related complications were recorded. Read More

Mil Med 2021 01;186(Suppl 1):316-323

Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.

Introduction: Rapid sequence intubation of patients experiencing traumatic hemorrhage represents a precarious phase of care, which can be marked by hemodynamic instability and pulseless arrest. Military combat trauma guidelines recommend reduced induction dose and early blood product resuscitation. Few studies have evaluated the role of induction dose and preintubation transfusion on hemodynamic outcomes. Read More

J Clin Monit Comput 2021 Jan 26. Epub 2021 Jan 26.

Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 156-707, Republic of Korea.

This study aimed to evaluate the 50% and 95% effective paratracheal forces for occluding the esophagus in anesthetized patients. In 46 anesthetized patients, the upper esophagus was examined using ultrasonography, and the lower paratracheal area over the esophagus just above the clavicle was marked. Manual paratracheal force was applied over that area using a novel pressure sensing device set-up. Read More

A A Pract 2020 Dec 17;14(14):e01360. Epub 2020 Dec 17.

From the Departments of Anesthesiology, Perioperative, and Pain Medicine.

This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. Adherence to the airway management protocol was high. Read More

Med Sci Monit 2021 Jan 14;27:e928462. Epub 2021 Jan 14.

Department of Anesthesiology, Dangyang People's Hospital, Dangyang, Hubei, China (mainland).

BACKGROUND This retrospective study was conducted at a single center in China and aimed to compare rocuronium with succinylcholine for rapid sequence induction intubation in the Emergency Department of a hospital. MATERIAL AND METHODS An orotracheal intubation procedure was performed in a total of 267 patients by direct laryngoscopy using an intravenous bolus injection of 1 mg/kg of succinylcholine (n=141; SY group) or 1.2 mg/kg of rocuronium (n=126; RM group) for a rapid sequence induction in the emergency department. Read More

Eur J Anaesthesiol 2021 02;38(2):199-200

From the Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (JK, MKo, PS, MKr).

Eur J Anaesthesiol 2021 02;38(2):198-199

From the Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Maribor, Slovenia (MZ), Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA (CAH), Department of Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele, Catania, Italy (MS) and Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (JB-E).

Anaesth Crit Care Pain Med 2021 02 23;40(1):100792. Epub 2020 Dec 23.

Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing 100050, PR China. Electronic address:

J Emerg Med 2021 Mar 9;60(3):265-272. Epub 2020 Dec 9.

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

Background: Rapid sequence intubation (RSI), defined as near-simultaneous administration of a sedative and neuromuscular blocking agent, is the most common and successful method of tracheal intubation in the emergency department. However, RSI is sometimes avoided when the physician believes there is a risk of a can't intubate/can't oxygenate scenario or critical hypoxemia because of distorted anatomy or apnea intolerance. Traditionally, topical anesthesia alone or in combination with low-dose sedation are used when physicians deem RSI too risky. Read More

Anaesth Rep 2020 Jul-Dec;8(2):98-100. Epub 2020 Aug 3.

Department of Anaesthesiology Saitama Medical University Hospital Saitama Japan.

Priming doses of non-depolarising neuromuscular blocking drugs given before administration of anaesthetic agents have been used to hasten the onset of neuromuscular blockade. In the settings of coronavirus disease 2019 (COVID-19), this could be used to reduce the apnoeic, and potentially aerosol-generating, window. To our knowledge, we report the first cases of tracheal intubation with rocuronium for COVID-19 using the priming principle. Read More

Emerg Med Clin North Am 2021 Feb 31;39(1):203-216. Epub 2020 Oct 31.

Multi Trauma Critical Care Unit, R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA.

There are subtle physiologic and pharmacologic principles that should be understood for patients with neurologic injuries. These principles are especially true for managing patients with traumatic brain injuries. Prevention of hypotension and hypoxemia are major goals in the management of these patients. Read More

Can J Anaesth 2021 Jan 21;68(1):137-147. Epub 2020 Oct 21.

Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, 123 Ta-Pei Road, Niao-Song District, Kaohsiung, 833, Taiwan.

Purpose: This meta-analysis aimed to assess the impact of cricoid pressure (CP) application on intubation outcomes.

Source: Electronic databases (i.e. Read More

BMC Anesthesiol 2020 10 13;20(1):262. Epub 2020 Oct 13.

Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, 6 Weizmann St., 6423906, Tel-Aviv, Israel.

Background: The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements' focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. Read More

J Spec Oper Med 2020 ;20(3):97-102

Based on limited published evidence, physiological principles, clinical experience, and expertise, the author group has developed a consensus statement on the potential for iatrogenic harm with rapid sequence induction (RSI) intubation and positive-pressure ventilation (PPV) on patients in hemorrhagic shock. "In hemorrhagic shock, or any low flow (central hypovolemic) state, it should be noted that RSI and PPV are likely to cause iatrogenic harm by decreasing cardiac output." The use of RSI and PPV leads to an increased burden of shock due to a decreased cardiac output (CO)2 which is one of the primary determinants of oxygen delivery (DO2). Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2020 May;45(5):603-608

Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.

Since the outbreak of COVID-19, the prevention and control of nosocomial infections has been highly valued. Airway management, including endotracheal intubation, extubation, and suction, has been considered as the high-risk virus-spreading procedures, which can put the health providers at a high risk of nosocomial infections. As hospitals at all levels will gradually resume their routine medical work, effective managements for the airway of the silent asymptomatic carriers and patients with delayed symptoms, treatment for severe patients, and prevention of cross infection in hospital have become the focus for the current prevention and control of nosocomial infections. Read More

Singapore Med J 2020 Aug 17. Epub 2020 Aug 17.

Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.

Introduction: General anaesthesia is associated with higher maternal morbidity and mortality, when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for caesarean delivery at a high-volume obstetric hospital in Singapore.

Methods: All parturients who underwent caesarean delivery under general anaesthesia in 2013-2016 were identified and medical records reviewed to extract pertinent data. Read More

Indian J Anaesth 2020 May 23;64(Suppl 2):S107-S115. Epub 2020 May 23.

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Read More

Respir Care 2020 Dec 28;65(12):1904-1907. Epub 2020 Jul 28.

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Data are limited regarding current practice and outcomes for emergency department airway management in status asthmaticus. This paper describes the foremost methods and outcomes of airway management in patients in the emergency department who required intubation for status asthmaticus.

Methods: We analyzed all intubations with a primary indication of asthma over a 3-y period (January 1, 2016 to December 31, 2018) using the National Emergency Airway Registry (NEAR), a 25-center, prospective, observational registry of emergency department intubations. Read More

Semin Cardiothorac Vasc Anesth 2021 03 22;25(1):76. Epub 2020 Jul 22.

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Semin Cardiothorac Vasc Anesth 2021 Mar 15;25(1):74-75. Epub 2020 Jul 15.

Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.

In this letter, the authors wonder about the need to apply some of the precautions that have been repeatedly suggested during the recent COVID-19 (coronavirus disease 19) pandemic not only to suspected or documented cases of infection but also to all the new cases entering the hospital. In this regard, orotracheal intubation has been universally recognized as a maneuver with a high risk of viral transmission. On the other hand, rapid sequence induction, which represents the gold standard for limiting the risk of transmission for health care professionals, implies side effects that can be potentially harmful for patients with impaired hemodynamics. Read More

J Cardiothorac Vasc Anesth 2020 Nov 19;34(11):3063-3067. Epub 2020 Jun 19.

Kitakyushu Municipal Medical Center, Department of Anesthesiology & Pain Medicine, Kitakyushu, Japan. Electronic address:

Objective: Esophagectomy is a highly invasive surgery, and it often is accompanied by various postoperative complications. With increases in the rate and length of patient survival in postoperative esophagectomy patients, the number of said patients receiving subsequent surgeries is increasing. However, airway management in post-esophagectomy patients is yet to be researched widely. Read More

Br J Anaesth 2020 10 28;125(4):e348-e349. 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.