Rapid sequence induction for appendectomies: a retrospective case-review analysis

Rapid sequence induction (RSI) with cricoid pressure is suggested to decrease the risk of aspiration of gastric contents. However, the effectiveness of RSI has been questioned, and the technique may lead to airway and hemodynamic complications. The purpose of this study was to determine the frequency of RSI use in patients with acute appendicitis, the types of drugs administered, and the occurrence of any complications.

After approval by the Ethics Committee, the charts of patients undergoing appendectomy in a one-year period were examined retrospectively. Information was retrieved on Mallampati airway evaluation, airway device used, preoxygenation, RSI, and drugs at induction. Reported complications were noted, including airway difficulties, hypotension (systolic blood pressure < 80 mmHg) and hypertension (>160 mmHg) in the 20-min period after induction.

General anesthesia with tracheal intubation was used in 248 of 250 cases reviewed. The Mallampati airway evaluation, preoxygenation, and RSI were recorded as performed in 95, 94, and 81% of cases, respectively. Opioids, propofol, and neuromuscular blocking agents were given in 98, 98, and 99% of patients, respectively. Succinylcholine use was common (80%), with 96% of these patients receiving rocuronium precurarization. Difficult intubation with successful alternate technique was encountered in three patients (1.2%). Hypotension and hypertension occurred in 27% and 8% of patients, respectively. There were no documented cases of aspiration. Oxygen desaturation was mentioned in one case at induction and in three cases at emergence.

An RSI with opioid, induction agent, and succinylcholine is the technique of choice for appendectomies at our institution. The frequency of airway complications is too low to recommend a change in practice.