Rapid sequence induction (RSI) is the method of coordinating the administration of rapidly acting induction agents to produce anaesthesia and muscle relaxation, followed by prompt intubation, resulting in a secure airway with the minimal risk of aspiration.

Roles

There are a number of pre-defined roles for healthcare staff during RSI:

• Airway
• Drug preparation
• Monitoring of vital signs
• Drug administration
• Cricoid pressure

Steps

There are a set of steps forming the sequence of RSI. These can be remembered by the 'seven P's'

• Preparation
  • Involves ensuring the environment is optimised, equipment is available and staff are ready
• Preoxygenation
  • Involves the administration of high flow oxygen for 5 minutes prior to the procedure
• Pretreatment
  • May involve administration of opiate analgesia or a fluid bolus to counteract the hypotensive effect of anaesthesia
• Paralysis
  • The administration of the induction agent (e.g. Propofol or Sodium Thiopentone) and paralysing agent (e.g. Suxamethonium or Rocuronium)
• Protection and positioning
  • Cricoid pressure should be applied to protect the airway following paralysis. In line stabilisation may be required in some cases.
• Placement and proof
  • Intubation is performed via laryngoscopy, with proof obtained (direct vision, end-tidal CO2, bilateral auscultation)
• Post-intubation management
  • Taping or tying the endotracheal tube, initiating mechanical ventilation and sedation agents