Rapid sequence induction

Rapid sequence induction/intubation
Intervention
Diagram showing the result of a successful RSI: an endotracheal tube (blue) inserted into the trachea (C), protecting the lungs from regurgitation through the esophagus (D).
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In advanced airway management, rapid sequence induction (RSI) - also described as rapid sequence intubation or as rapid sequence induction and intubation (RSII) - is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration or impending airway compromise. It differs from other forms of general anesthesia induction in that artificial ventilation is generally not provided from the time the patient stops breathing (when drugs are given) until after intubation has been achieved. This minimizes insufflation of air into the patient's stomach, which might otherwise provoke regurgitation.

"Classic" RSI involves pre-filling the patient's lungs with a high concentration of oxygen gas, followed by applying cricoid pressure, administering rapid-onset sedative or hypnotic and neuromuscular-blocking drugs that induce prompt unconsciousness and paralysis, inserting an endotracheal tube with minimal delay, and then releasing the cricoid pressure. "Modified" RSI refers to changes that deviates from the classic pattern, usually to reduce acidosis or improve oxygenation, but at the expense of increased regurgitation risk; examples of modifications include giving ventilations before the tube has been placed, or not using cricoid pressure.

The procedure is used where general anesthesia must be induced before the patient has had time to fast long enough to empty the stomach; where the patient has a condition that makes aspiration more likely during induction of anesthesia, regardless of how long they have fasted (such as gastroesophageal reflux disease or advanced pregnancy); or where the patient has become unable to protect their own airway even before anesthesia (such as after a traumatic brain injury).