• POCUS
• education
• gastric sonography
• gastric ultrasound
• training

• Humans
• Prospective Studies
• Male
• Female
• Ultrasonography/methods
• Middle Aged
• Stomach/diagnostic imaging
• Adult
• Aged
• Clinical Competence
• Point-of-Care Systems
• Time Factors

• GLP1
• POCUS
• fasting
• gastric ultrasound
• perioperative
• point-of-care ultrasound

• Humans
• Glucagon-Like Peptide 1
• Glucagon-Like Peptide-1 Receptor/agonists
• Gastrointestinal Tract/drug effects
• Gastrointestinal Tract/metabolism
• Obesity/drug therapy
• Obesity/metabolism
• Diabetes Mellitus, Type 2/drug therapy
• Diabetes Mellitus, Type 2/metabolism
• Incretins/therapeutic use
• Receptors, Gastrointestinal Hormone/agonists

• R01 DK067071 NIDDK NIH HHS
• R01 DK122280 NIDDK NIH HHS
• R01-DK122280 NIH HHS
• R01-DK67071 NIH HHS
• R01-DK67071 NIH HHS
• R01-DK122280 NIH HHS

• Glucagon
• Glucagon-like peptide-1
• Glucose-dependent inulinotropic polypeptide
• Incretin
• Metabolic dysfunction-associated steatohepatitis
• Metabolic dysfunction-associated steatotic liver disease
• Receptor agonist

• elderly
• gastric ultrasound
• old age
• preoperative
• pulmonary aspiration

• Aged
• Humans
• Middle Aged
• Pyloric Antrum/diagnostic imaging
• Prospective Studies
• Gastrointestinal Contents/diagnostic imaging
• Stomach/diagnostic imaging
• Ultrasonography

Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction.

The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations.

Online survey.

A total of 56 countries.

Members of the European Society of Anaesthesiology.

The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia.

From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O₂ for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH₂O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH₂O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741).

We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines.

ClinicalTrials.gov identifier: NCT03694860

• critical care
• education
• pain management
• technology
• ultrasonography

A substantial number of patients are at high-risk of intra- or post-operative complications or both. Most perioperative deaths are represented by patients who present insufficient physiological reserve to meet the demands of major surgery. Recognition and management of critical high-risk surgical patients require dedicated and effective teams, capable of preventing, recognize, start treatment with adequate support in time to refer patients to the satisfactory ICU level provision. The main task for health-care planners and managers is to identify and reduce this severe risk and to encourage patient’s safety practices. Inadequate tissue perfusion and decreased cellular oxygenation due to hypovolemia, heart dysfunction, reduced cardiovascular reserve, and concomitant diseases are the most common causes of perioperative complications. Hemodynamic, respiratory and careful sequential monitoring have become essential aspects of the clinical practice both for surgeons and intensivists. New monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to different therapies. Many of these techniques are now minimally invasive or non-invasive. Advanced hemodynamic and respiratory monitoring combines invasive, non-invasive monitoring skills. Non-invasive ultrasound has emerged during the last years as an essential operative and perioperative evaluation tool, and its use is now rapidly growing. Perioperative management guided by appropriate sequential clinical evaluation combined with respiratory and hemodynamic monitoring is an established tool to help clinicians to identify those patients at higher risk in the attempt to reduce the complications rate and potentially improve patient outcomes. This review aims to provide an update of currently available standard concepts and evolving technologies of the various respiratory and hemodynamic monitoring systems for the high-risk surgical patients, highlighting their potential usefulness when integrated with careful clinical evaluation.

• Capnography
• Goal-directed therapy
• Hemodynamic monitoring
• High-risk surgery
• Oxygen delivery
• Patient safety
• Ultrasound monitoring