Patients at aspiration risk (e.g. meal < 8 hours OR history of uncontrolled reflux OR recently vomiting) may receive Rapid Sequence Induction.
The goal of RSI is to minimize the time between when a patient cant protect their own airway (i.e. when they are awake and responsive) and when the anesthesiologist protects their airway for them (i.e. when the tube is in), in order to minimize the time the patient is at risk for aspiration.
Another major difference is that there is no bag-mask ventilation, as this could introduce air into the GI track causing vomiting. The steps for RSI are below:
- Preparation: check Allergies, Medications, Past med hx, Last meal, Events surrounding incident (AMPLE). Also check supplies and monitors.
- Preoxygenate: 100% for 3 minutes (spontaneous breathing).
- Pre-treat: opioids to reduce sympathetic response to intubation, raglan to reduce risk of gastric aspiration syndrome
- Paralysis and anesthesia: IV induction followed immediately by succinylcholine, often use propofol due to its anti- emetic action.
- Pass tube: immediately following fasiculations from succinylcholine
- Post-tube management: tape tube, opioids, etc, etc.
Cricoid pressure may or may not be applied (evidence poor that this significantly reduces aspiration).