Complications during rapid sequence induction of general anesthesia in children: a benchmark study

P>Objectives: Determine incidence of complications such as difficult or failed intubation, hypoxemia, hypotension, and bradycardia in children undergoing rapid sequence intubation (RSI) in a pediatric anesthesia department in a tertiary care children's hospital. Aim: To establish a benchmark to be used by other institutions and nonanesthesiologists performing RSI in children. Background: RSI is being increasingly performed in the nonoperating room setting by nonanesthesiologists. No published studies exist to establish a benchmark of intubation success or failure and complications in this patient population. Methods/Materials: Retrospective cohort analysis of children aged 3-12 undergoing RSI from 2001 to 2006. Results: One thousand seventy children underwent RSI from 2001 to 2006. Twenty (1.9%) developed moderate hypoxemia (SpO(2) 80-89%), 18 (1.7%) demonstrated severe hypoxemia (SpO(2) < 80%), 5 (0.5%) developed bradycardia (heart rate < 60), and 8 (0.8%) developed hypotension (systolic blood pressure < 70 mmHg). One patient had emesis of gastric contents but no evidence of pulmonary aspiration or hypoxemia. Eighteen (1.7%) children were noted to be difficult to intubate and required more than one intubation attempt. All were eventually intubated without significant complications. Patients between 10 and 19 kg had a higher incidence of severe hypoxemia when compared with older children (P < 0.001). There was no association between choice of muscle relaxant and any complication. Conclusions: In our cohort of 1070 children who underwent RSI, difficult intubation was encountered in 1.7% and transient oxyhemoglobin desaturation occurred in 3.6%. Severe hypoxemia was more likely in children < 20 kg. There were no children who could not be intubated, and there were no long-term or permanent complications

Anesthetic management of the pediatric bleeding tonsil

P>Background: Anesthetic management of the child with post-tonsillectomy hemorrhage is challenging and fraught with hazards such as anemia, hypovolemia, and risk of difficult airway. The aim of this retrospective cohort study was to determine the incidence and further define the anesthetic complications in this population. Methods: Retrospective cohort study of all children who underwent operative intervention for post-tonsillectomy hemorrhage (with or without adenoidectomy) from 1998 to 2005 at The Children's Hospital of Philadelphia. Anesthetic records were examined for independent (anesthetic techniques and patient characteristics) and dependent variables (ventilatory and hemodynamic complications). Results: Four hundred and seventy-five patients required surgery for exploration of post-tonsillectomy hemorrhage (incidence 2.9%). Intravenous rapid sequence induction was used in 401 (84.4%) patients. Succinylcholine was used in 420 (88%) patients. The most common adverse event (9.9%) was hypoxemia; most episodes occurred during emergence or extubation. Bradycardia during anesthetic induction occurred in 20 (4.2%) patients, and hypotension was noted in 12 (2.5%) patients. Thirteen (2.7%) patients were noted to be difficult to intubate, none of whom were difficult to intubate during the initial tonsillectomy. Conclusions: We determined our incidence of ventilatory and hemodynamic complications in a relatively large cohort of children with post-tonsillectomy hemorrhage. Transient hypoxemia was the most common complication and was not related to difficult intubation