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Rapid Sequence Induction

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2 views19 pages

Rapid Sequence Induction

Uploaded by

aqsay1052
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Rapid sequence

induction
Dr. Shaimaa H. Hasan
F.I.B.M.S. Anesthesia and Critical care
Definition
• Is a method of inducing anesthesia with precalculated drug in patient
who are at risk of aspiration of gastric contents into the lungs with
application of cricoid pressure

• Aim: To intubate the trachea as quickly & safely as possible

• applied daily especially during emergency surgery


Indication of RSI
• Patient with high risk of aspirations
• Abdominal pathology (ileus, Intestinal obstruction)
• Delayed gastric emptying (Pain, trauma, opioids, alcohol)
• Incompetent lower esophageal sphincter
• Altered conscious level lead to Impaired laryngeal reflex
• Neurological/neuromuscular disease
• Pregnancy
• Difficult airway
The Six ‘P’s of RSI

v Preparation
v Pre-Oxygenation with 100% oxygen
v Pretreatment & Induction
v Paralysis + Cricoid pressure
v Placement of the tube
v Post intubation management & strategy of failed intubation
Preparation

• Assess patient : Any features of difficult intubation


• IV Access: Adequate & Functioning
• Monitor
• Gather:
ü Equipment for intubation
ü Post intubation medication
ü Patient history
ü Supplies for surgical airway
Pre-Oxygenation Goals:
• Establish O2 reservoir
• Maximize time for intubation
• Prevent need for bag-mask ventilation
• Methods:
a) 3-5 minutes of 100% O2 via face mask
b) 5 Tidal capacity (5 Breaths)
Pre-Treatment Goals:
v Decrease adverse physiologic reactions to intubation
I. Sympathetic “pressor response” because manipulation of airway
will lead to ↑ Heart rate and blood pressure
II. Bronchospasm
III. Increased intracranial pressure
IV. Muscle Fasciculation

vBegins 2-3 minutes prior to induction/Paralysis


Induction hypnotic agent criteria
• Given as rapid IV push immediately before paralyzing agent

• Facilitate LOC in one-arm-brain circulation time in order to minimize


the time from LOC to intubation

• Should provide a rapid onset & a rapid recovery from anesthesia with
minimal CVS & Systemic side effect.
Induction muscle relaxant choice
Paralysis/NMB Agent Ideal:
• Rapid onset of action to minimize risk of aspiration & hypoxia
• Rapid recovery to facilitate the return of ventilation if intubation fails
• Minimal hemodynamics & systemic effect

Suxamethonium: Rapid onset & offset of action


Rocuronium: Rapid onset but duration of action much longer than
Suxamethonium

Wait for relaxation - Do not bag unless hypoxic because it will lead to
Insufflate air into the stomach & increase risk of vomiting/aspiration
Techniques Cricoid Pressure
üThe esophagus is occluded by extension of the neck & application of
pressure over the cricoid cartilage against the body of 5th cervical
vertebra to close esophageal lumen

üApplied an assistant with thumb & finger at either side of cricoid


cartilage

ü Maintain until after intubation & cuff inflation.


• Placement of tube Tube position is confirmed by:
a) Direct visualization of ET tube between the vocal cord
b) Auscultation: equal air entry
c) Capnometer: EtCO2

Post intubation care


1) ECG
2) SPO2
3) NIBP/Art-line
4) Capnograph
5) Naso/Orogastric tube
6) Maintenance of sedation & NMB
Terminating anesthesia
ü During transition from deep anesthesia to full consciousness & vice
versa risk of aspiration is greatest
ü Patient should be completely awake
ü Performing purposeful movement & responding to command
üConfirms patient can protect their own airway before removal of the
cuffed tube
üLeft lateral position – Protect airway during regurgitation
https://www.youtube.com/watch?v=0PQhse
OdFNQ
Complications of RSI
1. Failed to intubate & failed to ventilate
2. Risk of anaphylaxis
3. Cricoid pressure:
– Failure to occlude the esophagus
– Distortion of larynx lead to disrupt view
– Esophageal rupture during active vomiting

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