Rapid sequence induction intubation

SOAP ME mnemonic for rapid sequence induction/intubation Suction, Oxygen, Airway Equipment (including a... 

SOAP ME mnemonic for rapid sequence induction/intubation Suction, Oxygen, Airway Equipment (including a rescue/backup airway device or technique), Pharmacology, Monitoring Equipment SOB short of breath soln solution sp species... 

Perry J, Lee J, Wells G. Rocuronium versus succinylcho-hne for rapid sequence induction intubation (Cochrane Review). The Cochrane Library. Oxford Update Software, 2003 1. 

Perry JJ, Lee JS, Sillberg VA, Wells GA. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2008 (2) CD002788. 

Maximum block after suxamethonium develops in 60-90 seconds following a dose of 1 mg-kg-1 (about 3xED95) with a duration of action of 5-10 minutes. This dose provides near ideal intubating conditions in 60-90 seconds. It is because of a rapid onset and a short duration of action that suxamethonium is considered as the ideal agent for facilitating tracheal intubation during rapid sequence induction. 

Adrenocortical function has been assessed in a randomized trial after intravenous etomidate in 30 patients who required rapid-sequence induction and tracheal intubation (402). The controls received midazolam. Etomidate caused adrenocortical dysfunction, which resolved after 12 hours. 

Paralysis is preceded by muscular fasciculation, and this may be the cause of the muscle pain experienced commonly after its use. The pain may last 1-3 days and can be minimised by preceding the suxamethonium with a small dose of a competitive blocking agent. Suxamethonium is the neuromuscular blocker with the most rapid onset and the shortest duration of action. Tracheal intubation is possible in less than 60 seconds and total paralysis lasts up to 4 min with 50% recovery in about 10 min (t / for effect). It is particularly indicated for rapid sequence induction of anaesthesia in patients who are at risk of aspiration — the ability to secure the airway rapidly with a tracheal tube is of the utmost importance. If intubation proves impossible, recovery from suxamethonium and resumption of spontaneous respiration is relatively rapid. Unfortunately, if it is impossible to ventilate the paralysed patient s lungs, recovery may not be rapid enough to prevent the onset of hypoxia. 

Sparr HJ, Mellinghoff H, Blobner M, Noldge-Schomburg G. Comparison of intubating conditions after rapacuronium (Org 9487) and succinylcholine following rapid sequence induction in adult patients. Br J Anaesth 1999 82(4) 537-41. 

Zimmerman AA, Funk KJ, TidweU JL. Propofol and alfentanU prevent the increase in intraocular pressure caused by succinylchohne and endotracheal intubation during a rapid sequence induction of anesthesia. Anesth Analg 1996 83(4) 814-17. 

Systematic reviews Because of its fast onset of action, rocuronium is a potential alternative to suxamethonium for rapid-sequence intubation in patients with an increased risk of aspiration. Four relevant studies considering the use of suxamethonium and rocuronium in emergency departments were selected from an evidence search and a structured review performed [11 ]. For the outcomes of clinically acceptable intubation conditions and time to onset, the two agents were not statistically significantly different. Suxamethonium seems to produce conditions that have higher satisfaction scores. The authors concluded that suxamethonium remains the drug of choice for emergency department rapid-sequence induction, unless there is a contraindication. 

Sluga M, Ummenhofer W, StuderW, et al. Rocuronium versus sucdttylcho-line for rapid sequence induction of anesthesia and endotracheal intubation a prospective, randomized trial in emergent cases. Anesth Analg. 2005 101 1356-1361. 

RCC renal cell carcinoma RDA recommended dietary allowance RDS respiratory distress syndrome resp respiratory RLS restless leg syndrome ROSC recovery of spontaneous circulation RSI rapid sequence intubation/induction RSV respiratory syncytial virus RT radiation therapy RT reverse transcriptase... 

A very short-acting steroidal nondepolarizing agent (rapacuronium) was briefly introduced in the 1990s for rapid-sequence intubation and induction of anesthesia. It was withdrawn by the manufacturer because of concerns about life-threatening airway... 

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