Crush introduction to anesthesia

Definition

 * Mode of introduction to general anesthesia at high risk of aspiration.

Indication

 * Use in high risk of aspiration (fasting patient, ileus etc.).
 * The patient is not hungry (suspected abdominal sudden event, trauma) in acute admissions;
 * ileus, upper gastrointestinal bleeding;
 * gastric atony, pyloric stenosis, hiatal hernia, Gastroesophagic reflux, esophageal diverticula, esophageal atresia;
 * pregnant from the 2nd trimester;
 * patients under the influence of alcohol, comatose or intoxicated patients;
 * uremic patients;
 * patient with increased intracranial pressure;
 * clinically manifest hypothyroidism.

Preparing the patient

 * If there is time, the patient must be thoroughly prepared for the operation (medication to reduce stomach acidity with drugs such as – proton pump inhibitors, H2 receptor blockers, intestinal prokinetics, sodium citrate).
 * In case of a very high risk of aspiration (pylostenosis or ileus of the small intestine and at the same time the patient is not fasting), we must introduce a gastric tube and aspirate the contents of the stomach before starting anesthesia - the tube is then removed again, as it can serve as a guide for gastric secretions (however, some authors recommend leaving the tube ).
 * If vomiting occurs during intubation, we immediately place the patient in the Trendelenburg position to prevent gastric contents from leaking into the airway.

Procedure

 * 1) Reliable intravenous access.
 * 2) Insertion of a gastric tube and suction of the stomach (subsequent removal or pulling out of the gastric tube).
 * 3) After thorough preoxygenation (minimum 5 minutes).
 * 4) Constantly ready suction.
 * 5) We will perform an introduction to anesthesia (CAVE: WE DO NOT BREATHE THE PATIENT WITH THE MASK!) using a fast-onset muscle relaxant (Succinylcholine or Rocuronium).
 * 6) The assistant applies the Selick maneuver (by pressing on the annular cartilage, we compress the esophagus).
 * 7) After the onset of relaxation (with succinylcholine after the onset of muscle fasciculations) we intubate ALWAYS A TUBE WITH AN INSTALLED CONDUCTOR'.
 * 8) Breathing through the mask and verifying the position of the tube only after inflating the cuff of the tube.

Related Articles

 * Securing the airway
 * Securing the airways (half heels)
 * Endotracheal intubation
 * Difficult intubation