Rapid Sequence Induction and Intubation

Abstract

The changing opinion regarding some of the traditional components of rapid sequence induction and intubation (RSII) creates wide practice variations that impede attempts to establish a standard RSII protocol. There is controversy regarding the choice of induction drug, the dose, and the method of administration. Whereas some prefer the traditional rapid injection of a predetermined dose, others use the titration to loss of consciousness technique. The timing of neuromuscular blocking drug (NMBD) administration is different in both techniques. Whereas the NMBD should immediately follow the induction drug in the traditional technique, it is only given after establishing loss of consciousness in the titration technique. The optimal dose of succinylcholine is controversial with advocates and opponents for both higher and lower doses than the currently recommended 1.0 to 1.5 mg/kg dose. Defasciculation before succinylcholine was traditionally recommended in RSII but is currently controversial. Although the priming technique was advocated to accelerate onset of nondepolarizing NMBDs, its use has decreased because of potential complications and the introduction of rocuronium. Avoidance of manual ventilation before tracheal intubation was traditionally recommended to avoid gastric insufflation, but its use is currently acceptable and even recommended by some to avoid hypoxemia and to "test" the ability to mask ventilate. Cricoid pressure remains the most heated controversy; some believe in its effectiveness in preventing pulmonary aspiration, whereas others believe it should be abandoned because of the lack of scientific evidence of benefit and possible complications. There is still controversy regarding the best position and whether the head-up, head-down, or supine position is the safest during induction of anesthesia in full-stomach patients. These controversial components need to be discussed, studied, and resolved before establishing a standard RSII protocol.

Conventional right handed laryngoscope blade used as left handed blade: an experience with a case of mass in right side of oral cavity

“…8 With the use of short acting opioids like fentanyl and combination of inducing agents and short acting muscle relaxant, better haemodynamic profile can be achieved. 9 We used fentanyl, precalculated dose of propofol and ketamine, and succinylcholine to secure the airway and the haemodynamic changes was not significant.…”

Efeito da utilização de 2 mg.kg-1 de lidocaína endovenosa na latência de duas doses diferentes de rocurônio e na resposta hemodinâmica à intubação traqueal

“…the idea of reducing the latency of a neuromuscular blocker is clearly important when the anesthesiologist is facing the need of rapid-sequence intubation 36,37 . the main indication of this procedure is the prevention of bronchoaspiration in patients in a full stomach, the so-called Mendelson Syndrome 38 .…”

Sugammadex: An Update

“…While some authors consider that RSI with rocuronium is associated with fewer complications and better oxygenation during apnea, others report that succinylcholine provides better intubation conditions and shorter recovery time of failed intubation-failed ventilation scenarios [25][26][27]. These issues remain controversial and await further evidence.…”