Complications during rapid sequence induction of general anesthesia in children: a benchmark study

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Abstract
Summary: Objectives:  Determine incidence of complications such as difficult or failed intubation, hypoxemia, hypotension, and bradycardia in children undergoing rapid sequence intubation (RSI) in a pediatric anesthesia department in a tertiary care children’s hospital.Aim:  To establish a benchmark to be used by other institutions and nonanesthesiologists performing RSI in children.Background:  RSI is being increasingly performed in the nonoperating room setting by nonanesthesiologists. No published studies exist to establish a benchmark of intubation success or failure and complications in this patient population.Methods/Materials:  Retrospective cohort analysis of children aged 3–12 undergoing RSI from 2001 to 2006.Results:  One thousand seventy children underwent RSI from 2001 to 2006. Twenty (1.9%) developed moderate hypoxemia (SpO2 80–89%), 18 (1.7%) demonstrated severe hypoxemia (SpO2 < 80%), 5 (0.5%) developed bradycardia (heart rate P < 0.001). There was no association between choice of muscle relaxant and any complication.Conclusions:  In our cohort of 1070 children who underwent RSI, difficult intubation was encountered in 1.7% and transient oxyhemoglobin desaturation occurred in 3.6%. Severe hypoxemia was more likely in children <20 kg. There were no children who could not be intubated, and there were no long‐term or permanent complications.