scholarly journals Rapid sequence induction: where did the consensus go?

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
James Raitt ◽  
Hans Morten Lossius ◽  
David Lockey
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Hospital Environment ◽  
Training Technique ◽  
Rapid Sequence ◽  
Gastric Aspiration ◽  
Sequence Induction ◽  
The Uk ◽  
Key Aspects ◽  
Risk Of Aspiration

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

The Efficacy of Cricoid Pressure in Preventing Gastro-Oesophageal Reflux in Rapid Sequence Induction of Anaesthesia

2007 ◽  
Vol 17 (9) ◽  
pp. 432-436 ◽  
Author(s):  
Luke Ewart
Keyword(s):  
General Anaesthesia ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Rapid Sequence Induction ◽  
Evidence Base ◽  
Short Article ◽  
Rapid Sequence ◽  
Sequence Induction ◽  
Risk Of Aspiration ◽  
Induction Of Anaesthesia

Aspiration pneumonitis (AP) is a recognised complication of general anaesthesia (GA) that has an associated morbidity and mortality. Sellick's manoeuvre – the application of a sustained pressure to the cricoid cartilage – is one commonly taught anaesthetic practice that is deemed to reduce this risk of aspiration. However, this practice is not without its failings and some of the evidence base surrounding the use of cricoid pressure is examined in this short article.

Tonsillar Bleed

2018 ◽  
Author(s):  
Titilopemi A. O. Aina ◽  
Sharon Redd
Keyword(s):  
Risk Factors ◽  
Rapid Sequence Induction ◽  
Male Gender ◽  
Recurrent Tonsillitis ◽  
Surgical Scar ◽  
Rapid Sequence ◽  
Secondary Bleeding ◽  
Sequence Induction ◽  
Inflammatory Drugs ◽  
Risk Of Aspiration

Post-tonsillectomy hemorrhage (PTH) is a very serious complication that can occur after a tonsillectomy. There are two broad categories of PTH, based on onset of bleeding: primary (less than 24 hours) or secondary (greater than 24 hours). Primary bleeding is often attributed to the surgical technique, and secondary bleeding is attributed to sloughing of healing surgical scar. Risk factors for PTH include male gender, age greater than 70 years (in adults), age greater than 5 years (in pediatrics), recurrent tonsillitis, use of nonsteroidal anti-inflammatory drugs (particularly ketorolac), among others. Rapid-sequence induction and intubation is advised to reduce the risk of aspiration for patients presenting with PTH.

scholarly journals Audit on Current Practice of Rapid Sequence Induction and Intubation of Anesthesia in the University of Gondar Hospital, Northwest Ethiopia, 2018

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Mamaru Mollalign ◽  
Amare Hailekiros Gebreegzi ◽  
Habtamu Getinet ◽  
Seid Adem
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Northwest Ethiopia ◽  
Pulmonary Aspiration ◽  
Airway Control ◽  
Elective Surgical Procedures ◽  
Rapid Sequence ◽  
Audit Period ◽  
Sequence Induction ◽  
The University

Background. In patients who are liable to the risk of pulmonary aspiration, airway control is the primary and first concern for the anesthetists both in emergency and elective surgical procedures. Rapid sequence induction is universally required in any occasion of emergent endotracheal intubation needed for unfasted patients or patients’ fasting status is unknown. Methods. institutional-based prospective observational study was conducted from December 2017 to January 2018 in all elective and emergency adult or pediatric patients with a risk of pulmonary aspiration who were operated under general anesthesia with rapid sequence induction and intubation during the audit period. Result. A total of 35 patients were operated during the study period. Of these, 31 (88.57%) patients were adults and 4 (11.43%) patients were pediatrics. Most of the patients were emergency (29 (82.857%)), and the rest were elective (6 (17.142%)). Conclusion. Most anesthetists were good at preparing all available monitoring and drugs, making sure that IV line is well-functioning, preparing suction with a suction machine, preoxygenation, application of cricoid pressure, and checking the position of the ETT after intubation was performed. Preparing difficult airway equipment during planning of rapid sequence induction and intubation, giving roles and told to proceed their assigned role for the team, attempt to ventilate with a small tidal volume, and routine use of bougie or stylet to increase the chance of success of intubation needed improvement.

scholarly journals Rapid sequence induction/intubation controversies

2020 ◽  
pp. 102490792091083
Author(s):  
Prihatma Kriswidyatomo ◽  
Maharani Pradnya Paramitha
Keyword(s):  
Positive Pressure Ventilation ◽  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Rapid Sequence Intubation ◽  
Positive Pressure ◽  
Rapid Sequence ◽  
Sequence Induction

Backgrounds: Since its first definition and publication on 1970, Rapid Sequence Induction / Intubation (RSI) technique has been accepted globally as the “standard” for doing rapid intubation after induction of anesthesia for patients with high risk of aspiration, especially in emergency situation. However, this technique is not so much a “standard” as there are numerous variations on its practice based on national surveys. Anesthesia providers have their own opinions on the practice of RSI components which need to be discussed to assess their advantages and disadvantages, while there has been no review article which discussed these controversies in the last ten years. Objectives: To review the technique differences within RSI protocols. Methods: Online databases were searched, including MEDLINE and COCHRANE for each step in the original RSI protocol using keywords such as: “rapid sequence induction” or “rapid sequence intubation” or “RSI” and “controversies” or “head position” or “cricoid pressure” or “neuromuscular blocking agent” or “NMBA” or positive pressure ventilation” or “PPV”; and so on. Articles were then sorted out based on relevancy. Results and conclusion: Supported by new evidence, RSI practices may differ in: the positioning of patient, choices of induction agent, application of cricoid pressure, choices of neuromuscular blocking agent, and the use of positive pressure ventilation. A more updated and standardized guideline should be established by referring and evaluating to these controversies.

scholarly journals Comparison of rapid sequence induction intubation conditions with Suxamethonium verses Rocuronium.

2020 ◽  
Vol 27 (04) ◽  
pp. 759-764
Author(s):  
Aisha Ahmad ◽  
Samina Aslam ◽  
Amna Tariq ◽  
Robina Firdous ◽  
Humaira Ahmad ◽  
...  
Keyword(s):  
Cricoid Pressure ◽  
Controlled Trial ◽  
Rapid Sequence Induction ◽  
Induction Agent ◽  
Rapid Sequence ◽  
Sequence Induction ◽  
Group A ◽  
Random Number Table ◽  
Group B ◽  
Agent Group

Objectives: To compare endotracheal intubating conditions in rapid sequence induction using Suxamethonium and Rocuronium. Study Design: Randomized Controlled Trial. Setting: Allied Hospital Faisalabad. Period: From 02-07-2015 to 01-07-2016. Material & Methods: After taking approval from hospital ethical committee, cases of emergency surgery fulfilling the inclusion criteria were enrolled and informed consent was taken after explaining all the procedure to the patient. All the patients were randomly divided into 2 groups by using computer generated random number table. Both groups were induced with thiopentone sodium 5mg/kg, analgesia was given with nalbuphine 0.1mg/kg. Group A was given Suxamethonium in a dose of 1 mg/kg body weight after induction agent. Group B was given 0.6 mg/kg Rocuronium after induction. Intubation was performed after 60 sec in both groups with cricoid pressure. Anesthesia was maintained with O2/N2O in a ratio of 50:50 and isoflurane (0.6-1.0%) in both groups. Anesthesia was stopped at the end of surgery in all the patients. Results: Mean age of the patients was 40.49+11.47 and 43.43+12.88 years, 51.43% and 45.71% were male while 48.57% and 54.29% were females, Comparison of intubation conditions was recorded as 97.14% excellent and 2.86% good in patients received suxamethonium and 82.86% and 17.14% in Rocuronium Group had good conditions. Conclusion: It was found that Suxamethonium is significantly better when compared to Rocuronium for endotracheal intubation conditions in rapid sequence induction.

scholarly journals Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

JAMA Surgery ◽  
2019 ◽  
Vol 154 (1) ◽  
pp. 9 ◽  
Author(s):  
Aurélie Birenbaum ◽  
David Hajage ◽  
Sabine Roche ◽  
Alexandre Ntouba ◽  
Mathilde Eurin ◽  
...  
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Sham Procedure ◽  
Rapid Sequence ◽  
Sequence Induction

Applying Cricoid Pressure

2005 ◽  
Vol 15 (4) ◽  
pp. 164-168 ◽  
Author(s):  
Esther Gardiner ◽  
Eirlys Grindrod
Keyword(s):  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Sequence Induction

This article discusses the literature surrounding the application of cricoid pressure during rapid sequence induction and suggests ways in which the training of this skill can be improved.

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