11/30/2023 0 Comments Rapid sequence intubation history![]() Rapid sequence intubation is indicated when concern for aspiration exists, which. Choosing the appropriate premedication, induction drug, and paralytic will maximize the success of tracheal intubation and minimize complications.Įtomidate induction agents ketamine neuromuscular blockers premedications propofol rapid-sequence intubation. Guidelines for Rapid Sequence Intubation (RSI) I. RSI is used to secure a definitive airway in often uncooperative, nonfasted, unstable, and/or critically ill patients. Develop contingency plan for failed intubation (refer to UpToDate topics on devices for difficult endotracheal intubation). Citations from publications were reviewed for additional references.ĭata were reviewed to support the use or avoidance of premedications, induction agents, and paralytics and combinations to consider when drug shortages occur. The ‘classical’ approach to RSI, as advocated by Stept and Safar 2, describes pre-oxygenation, administration of a pre-determined dose of thiopental and suxamethonium, application of cricoid pressure, avoidance of face mask ventilation and intubation with a cuffed tracheal tube. and text words describing rapid sequence induction or intuba- tion (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation. ![]() Midazolam and propofol tend to be second. ![]() Sedatives are integral to the performance of rapid sequence intubation with typical 1st-line agents being etomidate and ketamine. and crash full-stomach inductions (exploration) rapid dissemination of RSI. ![]() To summarize published data regarding the steps of rapid-sequence intubation (RSI) review premedications, induction agents, neuromuscular blockers (NMB), and studies supporting use or avoidance and discuss the benefits and deficits of combinations of induction agents and NMBs used when drug shortages occur.Ī search of Medline databases (1966-October 2013) was conducted.ĭatabases were searched using the terms rapid-sequence intubation, fentanyl, midazolam, atropine, lidocaine, phenylephrine, ketamine, propofol, etomidate thiopental, succinylcholine, vecuronium, atracurium, and rocuronium. Primary literature and treatment guidelines recommend against the routine use of pre-treatment drugs in rapid sequence intubation. ![]()
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