Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Anders Gadegaard Jensen, T Callesen, J S Hagemo, K Hreinsson, V Lund, J Nordmark, Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.
OriginalsprogEngelsk
TidsskriftActa Anaesthesiologica Scandinavica
Vol/bind54
Udgave nummer8
Sider (fra-til)922-50
Antal sider29
ISSN0001-5172
DOI
StatusUdgivet - 1. sep. 2010

Fingeraftryk

Practice Guidelines
Emergencies
Consensus
Guidelines
Gastric Emptying
Ketamine
Hypnotics and Sedatives
Respiration
Medicine
Oxygen
Pharmaceutical Preparations

Citer dette

Gadegaard Jensen, A., Callesen, T., Hagemo, J. S., Hreinsson, K., Lund, V., Nordmark, J., & Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (2010). Scandinavian clinical practice guidelines on general anaesthesia for emergency situations. Acta Anaesthesiologica Scandinavica, 54(8), 922-50. https://doi.org/10.1111/j.1399-6576.2010.02277.x
Gadegaard Jensen, Anders ; Callesen, T ; Hagemo, J S ; Hreinsson, K ; Lund, V ; Nordmark, J ; Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. / Scandinavian clinical practice guidelines on general anaesthesia for emergency situations. I: Acta Anaesthesiologica Scandinavica. 2010 ; Bind 54, Nr. 8. s. 922-50.
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abstract = "Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.",
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Gadegaard Jensen, A, Callesen, T, Hagemo, JS, Hreinsson, K, Lund, V, Nordmark, J & Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine 2010, 'Scandinavian clinical practice guidelines on general anaesthesia for emergency situations', Acta Anaesthesiologica Scandinavica, bind 54, nr. 8, s. 922-50. https://doi.org/10.1111/j.1399-6576.2010.02277.x

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations. / Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S; Hreinsson, K; Lund, V; Nordmark, J; Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

I: Acta Anaesthesiologica Scandinavica, Bind 54, Nr. 8, 01.09.2010, s. 922-50.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

AU - Gadegaard Jensen, Anders

AU - Callesen, T

AU - Hagemo, J S

AU - Hreinsson, K

AU - Lund, V

AU - Nordmark, J

AU - Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

AB - Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1-1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

KW - Anaphylaxis

KW - Anesthesia, General

KW - Anesthetics

KW - Antacids

KW - Antiemetics

KW - Cholinergic Antagonists

KW - Cricoid Cartilage

KW - Emergency Medical Services

KW - Fasting

KW - Gastric Acidity Determination

KW - Gastric Emptying

KW - Humans

KW - Hypnotics and Sedatives

KW - Intubation, Intratracheal

KW - Muscle Relaxants, Central

KW - Narcotics

KW - Positive-Pressure Respiration

KW - Posture

KW - Preoperative Care

KW - Respiratory Aspiration

KW - Scandinavia

KW - Tidal Volume

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DO - 10.1111/j.1399-6576.2010.02277.x

M3 - Journal article

VL - 54

SP - 922

EP - 950

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 8

ER -