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

T Mencke1, A Zitzmann2, D A Reuter2

  • 1Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland. thomas.mencke@googlemail.com.

Der Anaesthesist
|March 7, 2018
PubMed
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This summary is machine-generated.

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Rapid sequence induction (RSI) is a critical anesthesia technique for patients at risk of aspiration. Modified RSI protocols, including mask ventilation and updated muscle relaxants, enhance safety and intubation conditions.

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:

Keywords:
Airway managementCricoid pressureIleusRocuroniumSuccinylcholine

Related Experiment Videos

  • 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.