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    Rapid Sequence Intubation and Cricoid Pressure

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    Erlin Irawati
    1) Rapid sequence intubation (RSI) is commonly used in emergency departments, with studies showing its use in 69-78% of intubation attempts. RSI aims to prevent hypoxia, minimize the time between induction and intubation, and decrease chances of pulmonary aspiration. 2) The RSI procedure involves pre-oxygenation, premedication, induction and muscle relaxation with fast-acting drugs, intubation, confirmation of tube placement, and post-intubation management. Cricoid pressure is often applied to help prevent regurgitation during intubation. 3) While cricoid pressure was originally proposed to prevent aspiration during intubation, the risks of complications from its application are

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    Rapid Sequence Intubation and Cricoid Pressure

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    Erlin Irawati
    88 views16 pages
    1) Rapid sequence intubation (RSI) is commonly used in emergency departments, with studies showing its use in 69-78% of intubation attempts. RSI aims to prevent hypoxia, minimize the time between induction and intubation, and decrease chances of pulmonary aspiration. 2) The RSI procedure involves pre-oxygenation, premedication, induction and muscle relaxation with fast-acting drugs, intubation, confirmation of tube placement, and post-intubation management. Cricoid pressure is often applied to help prevent regurgitation during intubation. 3) While cricoid pressure was originally proposed to prevent aspiration during intubation, the risks of complications from its application are

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    RSI and CP review article

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    Rapid sequence intubation and cricoid pressure

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    1) Rapid sequence intubation (RSI) is commonly used in emergency departments, with studies showing its use in 69-78% of intubation attempts. RSI aims to prevent hypoxia, minimize the time between induction and intubation, and decrease chances of pulmonary aspiration. 2) The RSI procedure involves pre-oxygenation, premedication, induction and muscle relaxation with fast-acting drugs, intubation, confirmation of tube placement, and post-intubation management. Cricoid pressure is often applied to help prevent regurgitation during intubation. 3) While cricoid pressure was originally proposed to prevent aspiration during intubation, the risks of complications from its application are

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    88 views16 pages

    Rapid Sequence Intubation and Cricoid Pressure

    Uploaded by

    Erlin Irawati
    1) Rapid sequence intubation (RSI) is commonly used in emergency departments, with studies showing its use in 69-78% of intubation attempts. RSI aims to prevent hypoxia, minimize the time between induction and intubation, and decrease chances of pulmonary aspiration. 2) The RSI procedure involves pre-oxygenation, premedication, induction and muscle relaxation with fast-acting drugs, intubation, confirmation of tube placement, and post-intubation management. Cricoid pressure is often applied to help prevent regurgitation during intubation. 3) While cricoid pressure was originally proposed to prevent aspiration during intubation, the risks of complications from its application are

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    of 16

    Jurnal Reading

    Rapid-sequence intubation
    and cricoid pressure
    Joshua C Stewart,Sanjay Bhananker,Ramesh
    Ramaiah
    Department of Anesthesiology and Pain Medicine,
    Harborview Medical Center, University of Washington
    School of Medicine, Seattle, Washington, USA

    Int J Crit Illn Inj Sci 2014;4:4

    Introduction
    In a multicenter longitudinal study of 8,937
    emergency department (ED) intubations from
    1997-2002, Wallset al., reported RSI was the
    initial method chosen in 6,138 of 8,937
    intubations (69%) and in 84% of all
    encounters that involved any intubation
    medication.
    Sagarinet al., noted that RSI was used in 78%
    of initial attempts and resulted in 85-91%
    success rate of tracheal intubation overall.

    Rapid Sequence Intubation at a


    Glance
    It is generally understood that RSI is
    used when tracheal intubation must
    be performed in a patient who is
    suspected of having a full stomach or
    is at risk for pulmonary aspiration of
    gastric contents.

    The procedure involves three


    objectives:
    Preventing
    hypoxia
    during
    the
    induction-intubation sequence;
    Minimizing
    the
    time
    between
    induction and tracheal intubation,
    when the airway is unprotected by
    the patient's reflexes or by the cuffed
    tracheal tube;
    Applying measures to decrease the
    chances of pulmonary aspiration of
    gastric contents.

    The
    first
    objectives
    is
    routinely
    accomplished
    by
    pre-oxygenation,
    typically 100% oxygen for 3-5 min before
    induction of anesthesia, allowing the
    patient to sustain apnea for a period of 5-8
    min
    without
    hypoxia.[5]The
    second
    objective involves minimization of the
    induction-intubation interval, suggesting
    that a fast-acting hypnotic agent should be
    administered along with a rapid onset
    neuromuscular blocking agent. Finally,
    measures to decrease the chance of
    aspiration
    include
    applying
    cricoid
    pressure (CP), refraining from positive
    pressure
    ventilation
    before
    tracheal

    The algorithm of RSI consist of six primary


    steps:
    Pre-oxygenation,
    premedication,
    induction and muscle relaxation, intubation,
    primary and secondary confirmation, and postintubation patient management.
    In a survey of current practice in the US,
    Rhenfield and associates established three
    defining features of a modified RSI: Oxygen
    administration before induction; the use of CP;
    and an attempt to ventilate the patient's lungs
    before securing the airway.

    FOCUS ON CRICOID
    PRESSURE

    CP relating to intubation was described by Sellick


    in 1961. Using a cadaver, he found that applying
    backward pressure to the cricoid cartilage against
    the cervical vertebrae could occlude the upper
    esophagus and prevent regurgitation of fluid into
    the pharynx. Sellick then tried the same maneuver
    during anesthesia induction in 26 patients, who are
    at increased risk for aspiration. None of the
    patients experienced regurgitation or vomiting
    when the pressure was applied, and three patients
    had immediate reflux into the pharynx upon
    release of the pressure after tracheal intubation.

    Laryngeal Anatomy and CP


    Application

    recommend
    using
    the
    three-finger CP
    technique
    as
    originally
    described
    by
    Sellickand
    thought
    that
    this technique
    is
    effective,
    easy to teach,
    and
    safely
    keeps
    the
    fingers in the
    midline of the

    It is suggested that 10 Newton's (N)


    of CP be applied just prior to loss of
    consciousness,
    increasing
    to
    approximately 30 N force at the
    onset
    of
    anesthesia.[43]The
    recommended force to prevent
    gastric reflux is between 30 and 40
    N, equivalent to 3-4 kg, but force
    greater than 20 N can cause pain
    and retching in awake patients, and a

    There
    are
    several
    potential
    complications to the application of
    CP, including but not limited to
    cricoid cartilage fracture, airway
    obstruction, esophageal rupture in
    situations of rapid increase in gastric
    pressure (i.e., vomiting) and even the
    potential for cervical spine or
    laryngeal trauma when significant
    manipulation of the head occurs.

    Conclusion
    RSI has proven to be, and will continue to remain an
    important tool available to the clinical practitioner for
    induction of anesthesia in applicable situations. The
    development
    of
    new
    drugs
    and
    the
    acceptance/validation of those less widely utilized will
    continue to advance the efficacy of the technique and
    ensure that the excellent level of safety RSI has come
    to provide does not falter. However, with the ever
    growing medical complexity of the patient population,
    standards and algorithms can never completely take
    the place of an actively vigilant provider, and must
    continue to be viewed as a guide for best practice.

    Conclusion
    In the matter of CP, we have not
    made any significant advancement in
    the immediate past to irrevocably
    answer the question as to whether or
    not the potential benefits of CP
    outweigh the potential risks such
    that every patient undergoing RSI
    should have CP applied.

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