Rapid Sequence Induction Explained
Jun 06, 2023The standard way of starting an anaesthetic involves preoxygenation, giving drugs, mask ventilation until the muscle relaxant has taken effect, and intubation. 💉😮💨✔️
A Rapid Sequence Induction (RSI) is slightly different ☝🏻
Here’s how:
It is used in patients at risk of aspiration. They include:
👉🏻Unfasted patients
👉🏻Patients with severe reflux
👉🏻Patients who have a reason for delayed gastric emptying (trauma, emergency cases, bowel obstruction)
How is it performed?
A “true” RSI has the following characteristics:
1️⃣Cricoid pressure is applied
As it theoretically compresses the oesophagus and prevents regurgitation
2️⃣Mask ventilation is AVOIDED
As it theoretically increases aspiration risk
3️⃣Suxamethonium is the muscle relaxant of choice
As it provides rapid paralysis with a clear end point (fasciculations)
However, a “modified” RSI is also very common:
👉🏻Cricoid may not be used
👉🏻Gentle mask ventilation may still be performed
👉🏻Rocuronium may be used
The ultimate goal is to safely intubate the patient, avoid desaturation, and prevent aspiration. If your team can achieve that, the exact technique doesn’t matter 👏👌
Check out our reel on cricoid pressure for more information! 🤓
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