Rapid sequence induction: a national survey of practice

We performed a national postal survey exploring anaesthetists' practice in rapid sequence induction. All respondents used pre-oxygenation, although th e technique employed, and its reliability, varied. Thiopental and succinylc holine, given after waiting for signs of loss of consciousness, were the mo st widely used drugs for rapid sequence induction. Propofol and rocuronium were used by more than a third of respondents, and most respondents (75%) a lso routinely administered an opioid. Cricoid pressure was used universally but the practice of its application varied widely. The commonest aids used if intubation was difficult were the gum elastic bougie, the long laryngos cope blade and the laryngeal mask. After failed intubation, approximately h alf of respondents would maintain the supine position. Failure to intubate at rapid sequence intubation had been seen by 45% of respondents but harm w as uncommon. In contrast, 28% had seen regurgitation, which frequently led to considerable harm and to three deaths. In spite of this, practice of a f ailed intubation drill was uncommon (15%) and anaesthetic assistants were r arely known to practice application of cricoid pressure. Consultants were l ess likely than trainees to use rocuronium. as a muscle relaxant, and more likely to choose morphine if administering an opioid. They were less likely to practice a failed intubation drill. Other aspects of practice varied li ttle between grades. This survey suggests that many anaesthetists do not fo llow best practice when performing a rapid sequence induction.