Pain Assessment During Rapid Sequence Induction

NCT07588165 | Not Yet Recruiting

• 1 other identifier: 26-03
• Study Type: observational
• Target: 150
• Locations: 0 countries
• Sites: N/A

Brief Summary

Rapid sequence induction (RSI) is a standard anesthesia technique used in patients at risk of aspiration. Although tracheal intubation following RSI is a frequent and painful procedure, no study has yet evaluated nociception using the Analgesia Nociception Index (ANI) during this procedure. This monocentric prospective observational study aims to describe the impact of RSI on pain measured by ANI, and to explore early complications (desaturation, hypotension, regurgitation) and factors associated with pain and complications. 150 patients undergoing RSI in the visceral surgery operating room at CHPG Monaco will be analyzed.

Conditions

Tracheal Intubation; Nociception; Rapide Sequence Induction; General Anesthesia

Keywords

Analgesia Nociception Index (ANI); Rapid Sequence Induction (RSI); Pain monitoring; Tracheal intubation; Hemodynamic response; General anesthesia

Outcome Measures

Primary Outcomes (1)

• Variation of the Analgesia Nociception Index (ANI) during the 5 minutes following rapid sequence intubation

  5 minutes post-induction

Secondary Outcomes (6)

• Variation of hemodynamic parameters (heart rate, systolic and diastolic blood pressure) during the 5 minutes post-RSI

  5 minutes post-induction

• Occurrence of regurgitation during RSI

  5 minutes post-induction

• First-attempt intubation success rate

  At time of intubation

• Variation of SpO2 during the 5 minutes post-RSI

  5 minutes post-induction

• Identification of factors associated with reduced pain (lower ANI variation)

  5 minutes post-induction

Interventions

No Intervention: Observational Cohort OTHER

Standard rapid sequence induction according to SFAR guidelines, with additional non-invasive ANI monitoring via cutaneous pectoral electrodes. No intervention beyond routine care; induction drug choice (hypnotic, opioid, neuromuscular blocker) at the discretion of the anesthesiologist.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patient requiring tracheal intubation after rapid sequence induction

You may qualify if:

• Age \>= 18 years
• Patient requiring tracheal intubation after rapid sequence induction in the visceral surgery operating room
• Pain monitoring by Analgesia Nociception Index (ANI) as part of general anesthesia

You may not qualify if:

• Patient with atrial fibrillation at the time of intubation following rapid sequence induction
• Patient on long-term beta-blocker therapy

Sponsors & Collaborators

• Centre Hospitalier Princesse Grace: lead

Related Publications (11)

• Alanoglu Z, Tolu S, Yalcin S, Batislam Y, Ozatamer O, Tuzuner F. Different remifentanil doses in rapid sequence anesthesia induction: BIS monitoring and intubation conditions. Adv Clin Exp Med. 2013 Jan-Feb;22(1):47-55.

  PMID: 23468262 BACKGROUND

• O'Hare R, McAtamney D, Mirakhur RK, Hughes D, Carabine U. Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth. 1999 Feb;82(2):283-5. doi: 10.1093/bja/82.2.283.

  PMID: 10365011 BACKGROUND

• Chaumeron A, Castanie J, Fortier LP, Basset P, Bastide S, Alonso S, Lefrant JY, Cuvillon P. Efficacy and safety of remifentanil in a rapid sequence induction in elderly patients: A three-arm parallel, double blind, randomised controlled trial. Anaesth Crit Care Pain Med. 2020 Apr;39(2):215-220. doi: 10.1016/j.accpm.2019.09.010. Epub 2019 Oct 12.

  PMID: 31614244 BACKGROUND

• Voeltzel J, Garnier O, Prades A, Carr J, De Jong A, Molinari N, Jaber S, Chanques G. Assessing pain in paralyzed critically ill patients receiving neuromuscular blocking agents: A monocenter prospective cohort. Anaesth Crit Care Pain Med. 2024 Aug;43(4):101384. doi: 10.1016/j.accpm.2024.101384. Epub 2024 May 6.

  PMID: 38710326 BACKGROUND

• Gruenewald M, Herz J, Schoenherr T, Thee C, Steinfath M, Bein B. Measurement of the nociceptive balance by Analgesia Nociception Index and Surgical Pleth Index during sevoflurane-remifentanil anesthesia. Minerva Anestesiol. 2015 May;81(5):480-9. Epub 2014 Jul 17.

  PMID: 25032676 BACKGROUND

• Funcke S, Sauerlaender S, Pinnschmidt HO, Saugel B, Bremer K, Reuter DA, Nitzschke R. Validation of Innovative Techniques for Monitoring Nociception during General Anesthesia: A Clinical Study Using Tetanic and Intracutaneous Electrical Stimulation. Anesthesiology. 2017 Aug;127(2):272-283. doi: 10.1097/ALN.0000000000001670.

  PMID: 28489614 BACKGROUND

• Grillot N, Gonzalez V, Deransy R, Rouhani A, Cintrat G, Rooze P, Naux E, Volteau C, Bouras M, Cinotti R, Roquilly A. Post-induction hypotension during rapid sequence intubation in the operating room: A post hoc analysis of the randomized controlled REMICRUSH trial. Anaesth Crit Care Pain Med. 2025 May;44(3):101502. doi: 10.1016/j.accpm.2025.101502. Epub 2025 Mar 12.

  PMID: 40086728 BACKGROUND

• Grillot N, Lebuffe G, Huet O, Lasocki S, Pichon X, Oudot M, Bruneau N, David JS, Bouzat P, Jobert A, Tching-Sin M, Feuillet F, Cinotti R, Asehnoune K, Roquilly A; Atlanrea Study GroupSociete Francaise d'Anesthesie Reanimation (SFAR) Research Network. Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA. 2023 Jan 3;329(1):28-38. doi: 10.1001/jama.2022.23550.

  PMID: 36594947 BACKGROUND

• Sajayan A, Wicker J, Ungureanu N, Mendonca C, Kimani PK. Current practice of rapid sequence induction of anaesthesia in the UK - a national survey. Br J Anaesth. 2016 Sep;117 Suppl 1:i69-i74. doi: 10.1093/bja/aew017. Epub 2016 Feb 24.

  PMID: 26917599 BACKGROUND

• Greer A, Hewitt M, Khazaneh PT, Ergan B, Burry L, Semler MW, Rochwerg B, Sharif S. Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials. Crit Care Med. 2025 Feb 1;53(2):e374-e383. doi: 10.1097/CCM.0000000000006515. Epub 2024 Nov 21.

  PMID: 39570063 BACKGROUND

• Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Crit Care Med. 2023 Oct 1;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000. Epub 2023 Sep 14.

  PMID: 37707379 BACKGROUND

Study Officials

• Remy WIDEHEM, MD

  Centre Hospitalier Princesse Grace

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Remy WIDEHEM

CONTACT

+377 97 98 99 00; remy.widehem@chpg.mc

Celine DUGOURD

CONTACT

+377 97 98 84 29; recherche.clinique@chpg.mc

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 8, 2026
• First Posted: May 14, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): May 1, 2028
• Study Completion (Estimated): May 1, 2028
• Last Updated: May 18, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share