[Certain and controversial components of "rapid sequence induction"]

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Surgical Safety

Background:

• Rapid sequence induction (RSI) is vital for patients with high aspiration risk, such as those undergoing cesarean sections or with intestinal obstruction.
• Anesthesia-related deaths are significantly linked to acute respiratory distress syndrome (ARDS) complications, despite its low incidence.
• Classical RSI protocols, established nearly 50 years ago, have seen minimal changes.

Purpose of the Study:

• To review the evolution and current components of rapid sequence induction (RSI).
• To discuss modifications to the classical RSI technique, including ventilation and muscle relaxant choices.
• To highlight the diminishing role of cricoid pressure and the importance of pre-operative gastric emptying.

Main Methods:

• Review of historical and contemporary rapid sequence induction (RSI) practices.
• Analysis of anesthetic agents and techniques used in RSI.
• Discussion of safety measures and patient preparation for RSI.

Main Results:

• Modified RSI may involve mask ventilation prior to intubation or the use of non-depolarizing muscle relaxants.
• Both succinylcholine (1.0 mg/kg) and rocuronium (1.0-1.2 mg/kg) are effective for achieving excellent intubation conditions.
• The use of cricoid pressure has become controversial and less emphasized in recent RSI protocols.
• Pre-operative gastric emptying via nasogastric tube is essential for patients with ileus or bowel obstruction.

Conclusions:

• Modern rapid sequence induction (RSI) incorporates modifications to improve patient safety and intubation success.
• The choice of muscle relaxants and the role of cricoid pressure are key areas of evolving RSI practice.
• Pre-operative gastric decompression is a crucial step in managing specific patient populations undergoing RSI.