Overview
There is a great heterogeneity in the practice of rapid sequence induction in the operating room in the world. There are no recent data assessing the rate of implementation of the latest French formalized expert recommendations in clinical practice. In addition, the modalities for the management of haemodynamic disorders, particularly hypotensive disorders, during rapid sequence induction are not described in these recommendations, although these are frequent events with a non-zero morbidity mortality potential.
The goal of this prospective, observational, multicenter, anesthetic study is to describe the clinical practice of French anesthesiologists regarding the prevention of severe hemodynamic disorders during rapid sequence anesthetic induction in adult patients.
The primary outcome measure is the occurrence of a major haemodynamic disorder defined by a MBP ≤ 50 mmHg (or ≤ 40% of the reference value) and/or ≥ 110 mmHg and/or the occurrence of sustained arrhythmia not present at induction and/or cardiac arrest within the first 10 minutes after induction of anesthesia.
The clinical practices of pre-oxygenation, induction and intubation of French anesthesiologists and compliance with the formalized expert recommendations of 2017 and 2018 will also be studied secondarily. The elements for the prevention of gastric fluid inhalation, the organization and equipment used, the anesthetic and non-anesthetic drugs used, the clinical and paraclinical neurological and cardio-respiratory parameters and the nature of the complications following anaesthetic induction will be collected up to the 10th post-induction minute.
Eligibility
Inclusion Criteria:
- Age ≥ 18 years' old
- Procedure requiring general anesthesia with oro or nasotracheal intubation
- Anesthetic management with indication of rapid sequence induction
- No objection after oral and written information to the patient
Exclusion Criteria:
- Age < 18 years' old
- Impossible intubation planned
- Preoperative respiratory distress (SpO2 < 90% in ambient air)
- Preoperative shock (MBP≤ 65 mmHg or vasopressive amines)
- Preoperative coma defined by a Glasgow score ≤ 12/15
- Patient in cardiopulmonary arrest
- Patients under guardianship or curatorship