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Pharmacological approach to rapid sequence induction/intubation: a contemporary perspective
Massimiliano Sorbello1,2, Daniele Salvatore Paternò2, Ivana Zdravkovic3
1Faculty of Medicine and Surgery, University of Enna 'Kore', Enna.
Current Opinion in Anaesthesiology
|June 10, 2025
Summary
Rapid sequence induction/intubation (RSII) has evolved, prioritizing patient safety by managing risks like hypoxemia and hemodynamic instability. Optimizing the first intubation attempt is crucial for better outcomes.
Area of Science:
- Anesthesiology
- Emergency Medicine
- Critical Care
Background:
- Rapid sequence induction/intubation (RSII) is a critical procedure for airway management.
- Historically, aspiration has been the primary concern during RSII.
Purpose of the Study:
- To review the 55-year evolution of pharmacological approaches in RSII.
- To highlight contemporary perspectives on managing full-stomach patients during airway control.
Main Methods:
- Review of historical and recent literature on RSII pharmacology and techniques.
- Analysis of complication rates and risk factors associated with RSII.
Main Results:
- Desaturation, hypoxemia, and hemodynamic instability are now recognized as greater risks than aspiration during RSII.
- Rocuronium is preferred over succinylcholine; ketamine and etomidate are favored for unstable patients.
- First-pass success rates are approximately 84%, with complications increasing significantly after multiple attempts.
Conclusions:
- Modern RSII balances aspiration prevention with avoiding hypoxemia and hemodynamic collapse.
- Thorough patient assessment, appropriate drug selection, positioning, and teamwork are essential.
- Prioritizing a successful first intubation attempt through preintubation optimization and human factors is key.
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