Práctica actual de la inducción de secuencia rápida en adultos: una encuesta nacional entre anestesiólogos en España / Current practice of rapid sequence induction in adults: a national survey among anesthesiologists in Spain

ANTECEDENTES: La inducción de secuencia rápida (ISR) en adultos ha experimentadcambios en los últimos años debido a los avances farmacológicos y tecnológicos. El objetivo de esta encuesta fue evaluar la práctica actual entre los anestesiólogos españoles. MÉTODOS: Se envió un cuestionario con 31 preguntas referentes a la práctica de la ISR a anestesiólogos de hospitales del Servicio Nacional de Salud de España. Las diferencias en las respuestas relacionadas con el tipo de hospital o experiencia se compararon para todos los datos utilizando el Chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: Aproximadamente el 15,89% de los anestesiólogos españoles participaron en la encuesta (1.002 cuestionarios). Los resultados muestran una gran heterogeneidad en la mayoría de los aspectos de la ISR. El citrato sódico es administrado por menos del 20% de los participantes. El 64% de los encuestados coloca una sonda nasogástrica en pacientes con obstrucción intestinal. El residuo gástrico se evalúa con ultrasonidos en un 6%. Una cuarta parte de los encuestados controla la eficacia de la preoxigenación con la ETO2 y el 22% utiliza la insuflación nasal de oxígeno con gafas nasales o THRIVE. El 62% de los encuestados aplica presión cricoidea, pero solo se libera en un 50% cuando aparece dificultad en la intubación. Hasta el 40% de los anestesiólogos refirieron haber tenido algún caso de aspiración a pesar de aplicar presión cricoidea. El propofol fue el hipnótico más utilizado (97,6%), mientras que no hubo una diferencia clara en la preferencia del relajante neuromuscular (ratio suxametonio versus rocuronio de aproximadamente 1:1). Solo el 44% de los encuestados calcula la dosis de sugammadex necesaria para una reversión de emergencia del rocuronio. CONCLUSIONES: La encuesta demostró una variación significativa en la práctica de la ISR, similar a la de otros países. Se necesitan estudios prospectivos de calidad para estandarizar la práctica clínica

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice

Current practice of rapid sequence induction in adults: A national survey among anesthesiologists in Spain. / Práctica actual de la inducción de secuencia rápida en adultos: una encuesta nacional entre anestesiólogos en España.

BACKGROUND: Rapid sequence induction (RSI) in adults has undergone changes in recent years due to pharmacological and technological advances. The objective of this survey was to evaluate current practice among Spanish anesthesiologists. METHODS: A 31-item questionnaire regarding RSI practice was sent to anesthesiologists working in Spanish public hospitals. Differences in responses according to the type of hospital or experience of the respondent were compared for all data using the chi-square and Fisher's exact test. RESULTS: Approximately 15.89% of Spanish anesthesiologists participated in the survey (1002 questionnaires). The results show considerable heterogeneity in most aspects of RSI. Less than 20% of respondents administer sodium citrate. Sixty-four percent place a nasogastric tube in patients with intestinal obstruction. Gastric residue is assessed by ultrasound in 6% of cases. Only 25% of respondents measure ETO2 to check the effectiveness of preoxygenation, and 22% use nasal oxygen insufflation with nasal prongs or THRIVE. Sixty two percent of respondents apply cricoid pressure, but only 50% release the pressure when encountering intubation difficulty. Up to 40% of respondents reported cases of aspiration despite applying cricoid pressure. Propofol was the most commonly used hypnotic (97.6%), but there was no clear preference in the choice of neuromuscular relaxant (suxamethonium versus rocuronium ratio of approximately 1:1). Only 44% of respondents calculated the dose of sugammadex that would be required for emergency reversal of rocuronium. CONCLUSIONS: The survey showed significant variation in RSI practice, similar to that of other countries. Quality prospective studies are needed to standardize clinical practice.