Using nasogastric suction but no cricoid pressure in rapid sequence induction of general anaesthesia: Outcome in a series of 224 cases of acute abdomen

Abstract

Background: Classic rapid sequence induction of general anaesthesia involves cricoid pressure. We, however, use an alternative because classical rapid sequence induction experience with hypoxaemia due to possible impedance of endotracheal intubation. A prospective observational study was performed to assess the safety and efficacy of the alternative induction technique. The objective was to determine the incidence of regurgitation of gastric contents when using this technique. Methods: During an 8-year period, general anaesthesia in patients suffering from acute abdomen was induced by placing them in a 150 reverse Trendelenberg position and using nasogastric suction in the peri-induction period. Peri-induction period was defined as the period from patient’s arrival in the operating room until immediately before starting the induction. Cricoid pressure was not applied. Their intra-abdominal pressure was also measured before general anaesthesia was induced. The incidence of regurgitation at induction was the end-point measure. Results: In 224 consecutive patients with mean intra-abdominal pressure at least two times higher than normal (mean pressure 23, 11.5 and 9 mmHg in adults, children & neonates respectively), no clinically identifiable incidence of regurgitation was noted (0/224 or 0%). Conclusion: Rapid sequence induction of general anaesthesia can be safely and successfully performed in patients suffering from acute abdomen using nasogastric suction and omitting cricoid pressure. The findings of this study justify the need to perform larger trials to further validate this technique. *Correspondence to: Muhammad Ajmal, Locum Anaesthetist, ID Medical locum agency, Milton Keynes, UK, Tel: 00447575770303; E-mail: Ajmal_c@hotmail.com