• Frank J Gencorelli, Ryan G Fields, and Ronald S Litman.
• Department of Anesthesiology, Hospital of the University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
• Paediatr Anaesth. 2010 May 1;20(5):421-4.

ObjectivesDetermine 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.AimTo establish a benchmark to be used by other institutions and nonanesthesiologists performing RSI in children.BackgroundRSI 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/MaterialsRetrospective cohort analysis of children aged 3-12 undergoing RSI from 2001 to 2006.ResultsOne 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.ConclusionsIn 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.

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