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Rapid Sequence Induction

German: Blitzeinleitung

1 Definition

Rapid sequence induction (RSI) is a special technique in anesthesiology to achieve airway management and general anesthesia in patients at higher risk of aspiration and regurgitation.

2 Procedure

The first step is - comparable to normal induction of general anesthesia - the preoxygenation of the patient for at least 5 minutes: In this technique, the patient is ventilated at 80-100% of oxygen via a tightly fitting face mask. Some authors suggest that a nasogastral feeding tube in the awake patient could also be used to further assist in preventing the reflux via reduction of the intragastral pressure. Before laying the patient down, it should be carefully removed under suction.

The following sequence is first, analgesics, generally an opioid, secondly, a hypnotic and finally, without the usual intermitting ventilation, the neuromuscular blocking, meaning that hypnotic medication and neuromuscular blockade are given in "rapid sequence". Following, the patient is intubated and the general anesthesia maintained. The application of pressure on the cricoid to prevent regurgitation, the so-called Sellick maneuver is discussed controversially.

3 Indication

RSI is indicated in patients who have high risk of aspiration or have to receive surgery without sufficient time for fasting.

Amongst these reasons are different patient groups:

4 Complications

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