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ABSTRACT: The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management.
In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed. OVID's therapy (sensitivity) algorithm was used to maximize the detection of randomized trials while excluding non-randomized research. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search.
A total of 184 clinical trials were identified of which 163 were randomized controlled trials (RCTs). Of these clinical trials, 126 evaluated different drug regimens with 114 being RCTs. Only 21 clinical trials evaluated non-pharmacologic aspects of the RSI with 18 RCTs identified. A parallel search found 52 trials evaluating cricoid pressure (outside of the context of an RSI technique) with 44 classified as RCTs. Definitive outcomes such as prevention of aspiration and mortality benefit could not be evaluated from the trials. Likewise, the impact on adverse outcomes of the different components of RSI could not be ascertained.
An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.
Canadian Journal of Anaesthesia 10/2007; 54(9):748-64. · 2.35 Impact Factor
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Canadian Journal of Anaesthesia 06/2007; 54(5):399-400. · 2.35 Impact Factor
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David T Neilipovitz
Canadian Journal of Anaesthesia 11/2004; 51(8):857-8; author reply 858-9. · 2.35 Impact Factor
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David T Neilipovitz
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ABSTRACT: Patients who undergo major spinal surgery often require multiple blood transfusions. The antifibrinolytics are medications that can reduce blood-transfusion requirements in cardiac surgery and total knee arthroplasty. The present role of synthetic antifibrinolytics, especially tranexamic acid, in reducing peri-operative blood-transfusion requirements in spine surgery is still unclear. The majority of studies exploring the role of these drugs in spine surgery have limited patient enrollment and report mixed results. The goal of the present review is to discuss the pharmacology of tranexamic acid briefly. A brief synopsis of the studies using the synthetic antifibrinolytics for spine surgery is presented. Finally, the potential risks and the benefits of antifibrinolytics are discussed.
European Spine Journal 11/2004; 13 Suppl 1:S62-5. · 1.97 Impact Factor
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ABSTRACT: To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery.
We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001. The search included textword searches using "autotransfusion," "cell salvage," "device," or Medical Subject Headings "autologous blood transfusion" or a "randomized controlled trials" filter.
Five randomized controlled trials (RCT) were identified involving cell salvage and vascular surgeries. In infra renal abdominal aortic aneurysm surgery the risk ratio (the risk of receiving at least one unit of allogeneic red cells) was 0.37 [95% confidence intervals (CI) of 0.06 to 2.36]. In elective aorto-femoral bypass surgery the risk ratio was 0.97 (95% CI of 0.66 to 1.42). The pooled risk ratio for cell salvage in vascular surgery was 0.67 (95% CI of 0.35 to 1.28).
Cell salvage, a commonly used technique to recover red cells from the operative field, has been the subject of several studies in vascular surgery. There is insufficient evidence to recommend the routine use of cell salvage in elective abdominal aortic aneurysm and aorto-femoral bypass surgeries. A large RCT would elucidate whether cell salvage is effective as a blood conservation technique.
Canadian Journal of Anaesthesia 06/2004; 51(5):425-31. · 2.35 Impact Factor
