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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 [1] – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration.
It is used for conscious sedation [7] [8] and as a part of a rapid sequence induction to induce anaesthesia. [9] [10] It is used as an anaesthetic agent since it has a rapid onset of action and a safe cardiovascular risk profile, and therefore is less likely to cause a significant drop in blood pressure than other induction agents.
In many countries, cricoid pressure has been widely used during rapid sequence induction for nearly fifty years, despite a lack of compelling evidence to support this practice. [7] The initial article by Sellick was based on a small sample size at a time when high tidal volumes, head-down positioning and barbiturate anesthesia were the rule. [8]
A cricothyrotomy is often used as an airway of last resort given the numerous other airway options available including standard tracheal intubation and rapid sequence induction which are the common means of establishing an airway in an emergency scenario. [2]
Despite newer anaesthetic agents and delivery techniques, which have led to more rapid onset of—and recovery from—anaesthesia (in some cases bypassing some of the stages entirely), the principles remain. Stage 1 Stage 1, also known as induction, is the period between the administration of induction agents and loss of consciousness. During ...
The Sellick Manoeuvre is typically only applied during a Rapid Sequence Induction (RSI), an induction technique reserved for those at high risk of aspiration. [citation needed] The Sellick maneuver was considered the standard of care during rapid sequence induction for many years. [3]
Now, because of the use of intravenous induction agents with muscle relaxants and the discontinuation of ether, elements of Guedel's classification have been superseded by depth of anaesthesia monitoring devices such as the BIS monitor; [5] however, the use of BIS monitoring remains controversial. [8]
Rapid sequence intubation is incorrect (and is erroneously used in some manuals and courses), as it is the induction of anaesthesia that is rapid sequence, not the intubation, which is secondary to the procedure, and performed at normal speed, and used to maintain a patent airway after RSI is complete.