Avaliação da técnica de indução em sequência rápida dos anestesiologistas de um hospital universitário

Ursula Bueno do Prado Guirro; Cesar Romão Martins; Masashi Munechika

doi:10.1590/S0034-70942012000300006

Scientific Article

Avaliação da técnica de indução em sequência rápida dos anestesiologistas de um hospital universitário

Assessment of anesthesiologists' rapid sequence induction technique in a university hospital

Ursula Bueno do Prado Guirro; Cesar Romão Martins; Masashi Munechika

http://dx.doi.org/10.1590/S0034-70942012000300006 Braz J Anesthesiol, vol.62, n3, p.340-345, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: A indução da anestesia geral em pacientes com "estômago cheio" pode resultar em regurgitação do conteúdo gástrico e aspiração pulmonar. A indução em sequência rápida (ISR) tem a função de minimizar o intervalo de tempo entre a perda dos reflexos protetores da via aérea e intubação traqueal com um tubo com balonete. O objetivo desse estudo foi avaliar a execução da indução em sequência rápida entre os anestesiologistas do Hospital São Paulo. MÉTODO: Os participantes responderam o questionário de forma voluntária e anônima, após esclarecimento e livre consentimento. O questionário continha 60 questões acerca dos pontos fundamentais da ISR. As questões se dividiam em pré-oxigenação, circuitos, drogas utilizadas na indução (opioides, hipnóticos, bloqueadores neuromusculares), técnicas de pressão cricoide, intubação e intubação difícil. RESULTADOS: Foram aplicados 75 questionários, sendo 22 descartados por preenchimento incompleto. Todos anestesiologistas declaram sempre realizar pré-oxigenação e administrar opioide, hipnótico e bloqueador neuromuscular. A maioria utiliza fentanila (83%), propofol (74,5%) e succinilcolina (68,6%). Todos anestesiologistas realizam pressão cricoide. A maioria não soube a pressão correta a ser aplicada na cartilagem cricoide. As falhas de intubação já ocorreram com 71,7% dos anestesiologistas e com 40% a regurgitação. Diante de uma intubação difícil e inesperada, 35,5% dos anestesiologistas solicitam máscara laríngea. CONCLUSÕES: Este estudo mostrou uma ampla variedade individual na técnica da ISR, fato já relatado por diversos autores. A dificuldade em se estabelecer um protocolo de ISR pode ser atribuída às constantes evidências que a ciência proporciona, fazendo da atualização parte da boa prática médica ao longo dos tempos.

Palavras-chave

cirurgia, urgência, complicações, intubação traqueal, aspiração pulmonar, sistema respiratório, vias aéreas

Abstract

BACKGROUND AND OBJECTIVES: The induction of the general anesthesia in patients on "a full stomach" can result in regurgitation of the gastric content and pulmonary aspiration. The function of the rapid sequence induction (RSI) is to minimize the time interval between the loss of the airway protection reflexes and tracheal intubation tube balloon. The objective of this study was to evaluate the rapid sequence induction among the anesthesiologists of the São Paulo Hospital. METHODS: The participants answered the questionnaire voluntarily and anonymously, after signed consent. The questionnaire consisted of 60 questions about the fundamental points of the RSI. The questions were divided in pre-oxygenation, circuits, drugs used in the induction (opioids, hypnotics, neuromuscular blockers), cricoid pressure techniques, intubation and difficult intubation. RESULTS: Seventy-five questionnaires were applied and 22 were discarded due to incomplete answering. All anesthesiologists always declare doing pre-oxygenation and administering opioid, hypnotic, and neuromuscular blocker. Most use fentanyl (83%), propofol (74.5%) and succinylcoline (68.6%). All anesthesiologists apply cricoid pressure. Most did not know the correct pressure to be applied on the cricoid cartilage. Intubation failures have already occurred with 71.7% of anesthesiologists and with 40%, the regurgitation. When faced with an unexpected difficult intubation, anesthesiologists ask for the laryngeal mask (35.5%). CONCLUSIONS: This study showed a broad individual variety of the RSI technique, a fact already reported by different authors. The difficulty in establishing a RSI protocol can be attributed to constant evidence that science provides us, where updating over the years becomes good medical practice.

Keywords

airway management, emergencies, intubation, intratracheal, laryngopharyngeal reflux, respiratory aspiration

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Avaliação da técnica de indução em sequência rápida dos anestesiologistas de um hospital universitário

Assessment of anesthesiologists' rapid sequence induction technique in a university hospital

Ursula Bueno do Prado Guirro; Cesar Romão Martins; Masashi Munechika

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