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Concept
Rapid sequence induction
Summary
In anaesthesia and advanced airway management, rapid sequence induction (RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) or as crash induction – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration. It differs from other techniques for inducing general anesthesia in that several extra precautions are taken to minimize the time between giving the induction drugs and securing the tube, during which period the patient's airway is essentially unprotected.
One important difference between RSI and routine tracheal intubation is that the anesthesiologist does not typically manually assist the ventilation of the lungs after the onset of general anesthesia and cessation of breathing until the trachea has been intubated and the cuff has been inflated. RSI is typically used in patients who are at high risk of aspiration or who are critically ill and may be performed by anaesthesiologists, intensivists, emergency physicians or, in some regions, paramedics.
This procedure is used where general anesthesia must be induced before the patient has had time to fast long enough to empty the stomach; where the patient has a condition that makes aspiration more likely during induction of anesthesia, regardless of how long they have fasted (such as gastroesophageal reflux disease or advanced pregnancy); or where the patient has become unable to protect their own airway even before anesthesia (such as after a traumatic brain injury).
There are relatively few absolute contraindications to a rapid sequence induction. The most significant contraindications include facial trauma that significantly distorts upper airway anatomy or complete airway obstruction (i.e. oropharyngeal cancer, hematoma, etc). In these cases, airway management is secured via a surgical airway instead.
There are several possible complications associated with RSI. The most concerning complication is airway management in a paralyzed patient.
Official source
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