Definition (1): rapid sequence induction and intubation (RSII) is an anesthesia induction technique designed to facilitate rapid tracheal intubation in patients at high risk of aspiration.  Treatment: - The traditional recommendation is to rapidly inject a precalculated dose of induction drug immediately followed by the neuromuscular blocking drug (NMBD) (1).
- The thiopental titration group (followed by succinylcholine) had a shorter mean time to intubation (70 vs 78 seconds) (2).
- Traditionally, opioids were not included among the induction drugs in RSII (3).
- Similar to opioids, there are opposing opinions regarding the benefits of using lidocaine in RSII (1).
- The use of the timing technique (single bolus of a nondepolarizing NMBD followed by the induction drug) is associated with the same risks that can occur after priming, including pulmonary aspiration before anesthesia induction (1).
- Avoidance of positive pressure ventilation before tracheal intubation has been the classic recommendation in RSII (1).
- The failure to establish a standard RSII technique may be attribuable to the changing opinion regarding some of the technique's traditional components (1).
References:- Mohammad El-Orbany et al. Rapid Sequence Induction and Intubation: Current Controversy. Anesthesia & Analgesia. 2010;110(5):1318-1325: full text | pdf.
- Barr AM et al. Thiopentone and suxamethonium crash induction. An assessment of the potential hazards. Anaesthesia. 1976;31:23-9: pdf.
- Stept WJ et al. Rapid induction/intubation for prevention of gastric-content aspiration. Anesthesia & Analgesia. 1970;49:633-6: full text | pdf.
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