Anaes SAQs · Airway management

Rapid sequence induction and modified RSI — preoxygenation, cricoid pressure debate, and the modern approach

The core RSI short-answer question — the principle (minimising the unprotected interval to protect against pulmonary aspiration), the indications (full stomach, pregnancy, bowel obstruction, trauma, delayed gastric emptying, the emergency and critical-care intubation), the seven-step classical sequence (preoxygenation, pre-treatment, induction, paralysis, no mask ventilation with cricoid pressure, intubation, confirmation and release), the cricoid pressure controversy (anatomical unreliability, impaired laryngoscopic view, airway obstruction, cervical spine movement; optional and released if interfering), and the modified RSI (gentle mask ventilation, reduced or omitted cricoid pressure, THRIVE high-flow nasal apnoeic oxygenation at 70 L per min, video laryngoscopy, rocuronium at RSI dose reversible by sugammadex 16 mg per kg), with the induction agent choice governed by haemodynamic reserve (reduce propofol or thiopental, or use ketamine or etomidate, with a vasopressor drawn up).