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Topic: Rapid sequence induction

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	Rapid Sequence Induction for Prehospital Providers
		Rapid sequence induction or RSI, has just this goal in mind and to be performed successfully, takes experience, a thorough understanding of it’s indications, contraindications and limitations, and a working knowledge of the physiology and pharmacology of agents used.
		Rapid sequence induction (RSI) is the use of pharmacologic agents to aid in establishing a definitive airway.
		Induction = the use of pharmacologic agents, whether it be intravenous solutions or inhaled gases, that act on the brain to quickly move from consciousness to unconsciousness; to create a plane or level of anesthesia.
	www.ispub.com /ostia/index.php?xmlFilePath=journals/ijeicm/vol4n1/rapid.xml (5410 words)

	eMedicine - Rapid Sequence Induction : Article by Keith A Lafferty, MD (Site not responding. Last check: 2007-08-06)
		RSI involves the rapid injection of preselected doses of an anesthetic agent and a muscle relaxant by using doses that are estimated on the basis of a patient's weight and the appropriate degree of anesthesia.
		The induction dose is 2 mg/kg, and it produces a dose-dependent and potent depression of consciousness ranging from light sedation to a comatose state.
		Because of its rapid onset, ultrashort duration of action, and safety, it is the paralytic of choice in almost all cases of RSI in adults.
	www.emedicine.com /emerg/topic939.htm (11866 words)

	Rapid sequence induction for trauma - TraumaWiki (Site not responding. Last check: 2007-08-06)
		Rapid sequence induction of anaesthesia (RSI) is a method of rapidly producing optimal conditions for intubation in the emergency situation.
		This is the hallmark of a Rapid Sequence Induction
		Ketamine is different from the previous IV induction agents in that it induces a state of 'dissociative anaesthesia', with sedation, amnesia, profound analgesia and immobility.
	beta.trauma.org /traumawiki/index.php?title=Rapid_sequence_induction_for_trauma (3178 words)

	eMedicine - Rapid Sequence Induction - Induction and Pretreatment Medications : Article by Ted Stettner, MD (Site not responding. Last check: 2007-08-06)
		In recent years, rapid sequence intubation (ie, rapid sequence induction [RSI]) has become the technique of choice for emergent airway management and is a skill that all emergency physicians must master.
		Following this, an induction agent is administered to provide sedation and amnesia, and a paralytic agent is usually administered to provide muscle relaxation.
		The induction phase of RSI is performed to produce sedation and anesthesia.
	www.emedicine.com /emerg/topic938.htm (3568 words)

	Remifentanil Prevents the Hemodynamic Response to Orotracheal Intubation
		McAtamney et al administered remifentanil in several doses as part of a rapid sequence technique using thiopental and rocuronium 0.75 mg/kg for induction of anesthesia.
		Succinylcholine is commonly used to facilitate endotracheal intubation for rapid sequence induction.
		The rapid metabolism of remifentanil, however, makes this an ideal agent compared with alfentanil for surgery of short duration or when the effects of opioids may be undesirable for a prolonged period of time (e.g., cesarean section).
	www.jrnlappliedresearch.com /articles/Vol1Iss2/Alexander.htm (2176 words)

	Rapid Sequence Induction (via CobWeb/3.1 planetlab2.cs.virginia.edu) (Site not responding. Last check: 2007-08-06)
		Rapid sequence induction (1(81) is used for patients who are at high risk for acid aspiration.
		The concept of RSI is to go as quickly as possible from the awake state to the anesthetized, endotracheally intubated state.
		This is done by first preoxygenating the patient, then giving thiopental (or another intravenous induction agent) together with succinyicholine, waiting 60 seconds and intubating the trachea.
	www.anesth.utmb.edu.cob-web.org:8888 /Venable/Students/Introduction/14rsi.html (200 words)

	Rocuronium versus succinylcholine for rapid sequence induction intubation (Cochrane Review) (Site not responding. Last check: 2007-08-06)
		Overall rocuronium is less effective than succinylcholine, except when propofol is the agent used for rapid induction of anaesthesia.
		Patients requiring emergent endotracheal intubation often require a rapid sequence induction intubation (RSI) technique to protect against gastric aspiration, to facilitate intubation, or to protect against increased intracranial pressure.
		In the group that used propofol for induction of anaesthesia, the intubation conditions were similar, with a RR=0.96 (95%CI = 0.87 to 1.06) (N=640).
	www.update-software.com /abstracts/AB002788.htm (537 words)

	[No title]
		The two main risks factors for developing bronchospam were rapid sequence induction and prior history of reactive airway disease.
		Clinical experience supports the association between rapid injection of the drug and the ensuing development of bronchospasm in children.
		Rapid injection most commonly occurs in the setting of a rapid sequence induction.
	www.anes.uab.edu /aneshist/AHA2005Sparrow.doc (643 words)

	[No title]
		A recent study comparing awake, rapid-sequence, or modified rapid sequence inductions demonstrated faster, more successful intubations when the babies were paralyzed.
		In this study, atracurium (0.4-0.5 mg/kg), vecuronium (0.1-0.2 mg/kg) or rocuronium (0.6-1 mg/kg) were used for a modified rapid sequence induction.
		Generally, I use a rapid sequence induction with pentothal (4-6mg/kg)and succinylcholine (2 mg/kg).
	www.aims.unc.edu /resources/knowledgebase/entry.aspx?id=128 (609 words)

	Rapid sequence induction and intubation
		The tube may be secured in a variety of ways, all that is important is that it is held tightly, and can not slide up and down the trachea.
		It is not conventional to premedicate patients undergoing rapid sequence induction or to administer sedatives such as midazolam or fentanyl prior to the administration of anaesthesia.
		We avoid manually ventilating patients undergoing rapid sequence induction, as this inflates the stomach and encourages regurgitation.
	www.4um.com /tutorial/anaesth/rsi.htm (1483 words)

	Prehospital rapid sequence induction by emergency physicians: Is it safe? -- Mackay et al. 18 (1): 20 -- Emergency ...
		Rapid sequence induction with oral endotracheal intubation in the multiply injured patient.
		Rapid sequence induction for intubation by an aeromedical transport team: a critical analysis.
		Sivilotti MLA, Ducharme J. Randomised double-blind study on sedatives and haemodynamics during rapid sequence intubation in the emergency department: the SHRED study.
	emj.bmjjournals.com /cgi/content/full/18/1/20 (2646 words)

	Anaesthesia UK : FRCA Journal : Intubation conditions after rocuronium or succinylcholine for rapid sequence ...
		Patients scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric contents were randomized to a rapid-sequence induction with succinylcholine 1.0 mg/kg or rocuronium 0.6 mg/kg.
		The results showed that during a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg/kg and succinylcholine 1.0 mg/kg provide clinically acceptable intubation conditions in 60 seconds in patients scheduled for emergency surgery.
		The authors conclude that, under the conditions of this rapid-sequence induction regimen, rocuronium may be a substitute for succinylcholine.
	www.frca.co.uk /JournalView.aspx?jid=168 (283 words)

	EMT City - Paramedic and EMT Forum and Chat :: View topic - RSI
		A rapid sequence induction of anesthesia and endotracheal intubation are indicated in emergency situations in the presence of a full stomach or other conditions with an increased risk of aspiration.
		Endotracheal intubation conditions during rapid sequence induction of anesthesia and endotracheal intubation with succinylcholine or rocuronium as the neuromuscular blocking drug.
		Choosing rocuronium instead of succinylcholine for rapid sequence induction of anesthesia prolongs the time of unprotected airway, i.e., the time interval from beginning of the induction until completion of endotracheal intubation, from a median time of 95 seconds to a median time of 130 seconds.
	www.emtcity.com /phpBB2/viewtopic.php?p=74543 (10030 words)

	Chest -- eLetters for Reynolds and Heffner, 127 (4) 1397-1412
		We disagree with the use of succinylcholine as the best NMBA in rapid-sequence intubation in critically ill patients.1 Most patients undergoing a rapid sequence intubation have altered mental status, respiratory insufficiency or are combative.
		Rocuronium, since rapacuronium was withdrawn, is currently the best alternative to succinylcholine for rapid sequence induction.3 This new agent has an excellent security profile and little secondary effects in critically ill patients.
		Frequency of haemoglobin desaturation with the use of succinylcholine during rapid sequence induction of anaesthesia.
	www.chestjournal.org /cgi/eletters/127/4/1397 (442 words)

	BestBETs: Rapid sequence induction in the emergency departme...
		He needs to be intubated via a rapid sequence induction and you wonder whether you should do this, as you have previous anaeasthetic training or call the anaesthetists down to do it for you.
		Although many papers look only at the performance of emergency physicians, there appears to be ample evidence that emergency physicians can perform rapid sequence induction and endotracheal intubation at least as well as anaesthetists, and there is overall a high success rate with a low complication rate.
		Rapid sequence intubation of trauma patients in Scotland.
	www.bestbets.org /cgi-bin/bets.pl?record=01066 (961 words)

	Texas Dept of Health - Bureau of Emergency Management (Site not responding. Last check: 2007-08-06)
		The ground ambulance does not have the capability to utilize paralytic medications to facilitate intubation (often called rapid sequence induction intubation, or RSII).
		Usually indicated for patients who cannot be endotracheally intubated via other means, RSII utilizes a combination of medications to sedate and paralyze a patient, allowing easier intubation in most cases.
		Rapid Sequence Induction Intubation (RSII) is a protocol usually indicated for patients who cannot be endotracheally intubated via other means.
	www.tdh.state.tx.us /hcqs/ems/CESO01.htm (3271 words)

	MHRI Paramedicine - Anesthesia (Site not responding. Last check: 2007-08-06)
		During the anesthesia rotation, students learn airway management skills and become familiar with anesthetic, induction and neuromuscular blocking agents as well as the process of rapid sequence induction.
		Describe the pharmacologic and physiologic properties of the pretreatment, induction, and neuromuscular blocking agents utilized during rapid sequence induction and intubation.
		Become familiar with the administration and use of induction and neuromuscular blocking agents for rapid sequence induction and intubation.
	ems.mhri.org /ans.htm (269 words)

	Survey of the use of rapid sequence induction in the accident and emergency department -- Walker and Brenchley 17 (2): ...
		Survey of the use of rapid sequence induction in the accident and emergency department -- Walker and Brenchley 17 (2): 95 -- Emergency Medicine Journal
		Survey of the use of rapid sequence induction in the accident and emergency department
		Rapid sequence induction technique for orotracheal intubation of adult non-trauma patients in a community hospital setting.
	emj.bmjjournals.com /cgi/content/full/17/2/95 (1712 words)

	abstract (Site not responding. Last check: 2007-08-06)
		Rapid-sequence induction of anesthesia (RSIA) is believed to minimize risk of aspiration in unfasted patients and is widely used in obstetric anesthesia for emergency cesarean section.
		Thiopental was the induction agent of choice for 96%.
		Thwaites AJ et al., Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation.
	www.theairwaysite.com /abstract.php?61 (283 words)

	Rapid sequence induction and intubation
		Rapid sequence induction is used in trauma cases where emergency surgery is required.
		Preparation- the drugs should be prepared (Etomidate for induction, Suxamethonium for muscle relaxation, Atropine to counteract the effects of Etomidate and ephedrine, to counteract any bradycardia or respiratory depression that may occur)
		In terms of haemodynamic disturbance and cardiac stability, Etomidate is preferred, producing fewer cardiac side-effects (thiopental produces cardiac and respiratory depression).
	www.portfolio.mvm.ed.ac.uk /studentwebs/session6/55/drugs.htm (949 words)

	BestBETs: Cricoid pressure in emergency Rapid Sequence Induc...
		You are about to perform a rapid sequence intubation on a 26 year old man with a severe head injury.
		Cricoid pressure has been described as the 'linchpin of rapid sequence induction' and has become widely accepted as the standard of practice during anaesthesia in the UK and US.
		There is little evidence to support the widely held belief that the application of cricoid pressure reduces the incidence of aspiration during a rapid sequence intubation.
	www.bestbets.org /cgi-bin/bets.pl?record=00261 (509 words)

	CFI Program
		Although not well founded in the literature, the fears of improper airway management of the chemically paralyzed patient and prolonged scene times appear to be the greatest concerns for use of paralytics in the ground prehospital services.
		As part of the rapid sequence induction protocol for University MedEvac, the first step is an induction dose of midazolam (0.1 mg/kg).
		Protocol development and education and skill maintenance would be less complicated than for a complete rapid sequence induction program and may be more readily accepted by the medical community.
	www.allentownems.org /cfi.htm (798 words)

	General anesthesia for obstetrics: a deadly or a winning combination -- Douglas 51 (Supplement 1): R5 -- Canadian ...
		rapid induction may be needed for maternal safety include uncontrolled
		The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective cesarean section: a prospective study of 1067 cases.
		Inhalational induction of anaesthesia for caesarean section: not to be sniffed at?
	www.cja-jca.org /cgi/content/full/51/suppl_1/R5 (2172 words)

	Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation: A ...
		Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation: A Prospective, Randomized Trial in Emergent Cases -- Sluga et al.
		Rocuronium Versus Succinylcholine for Rapid Sequence Induction of Anesthesia and Endotracheal Intubation: A Prospective, Randomized Trial in Emergent Cases
		We conclude that during rapid sequence induction of anesthesia
	www.anesthesia-analgesia.org /cgi/content/abstract/101/5/1356 (358 words)

	General Anesthesia for Cesarean Section
		All OB patients are considered to have full stomachs and therefore require awake intubation or rapid sequence induction if airway appears adequate.
		Rapid sequence induction: cricoid pressure, pentothal 4 mg/kg, succinylcholine 1.5 mg/kg
		Rapid infusion until uterus contracts, then slow drip.
	faculty.washington.edu /chadwick/ob/ga-cs.htm (298 words)

	Pulmonary Aspiration MEDSTUDENTS-ANESTHESIOLOGY
		Patients who are supposed to have easy intubations, may receive a rapid sequence induction, which consists of preoxygenating the patient and placing pressure over the cricoid cartilage Sellick maneuver.
		Awake intubation is an alternative to patients with difficult airways, because it allows spontaneous breathing and protects the airway from aspiration.
		It should be done with topical local anesthetic and the judicious use of sedation, before induction of general anesthesia.
	www.medstudents.com.br /anest/anest2.htm (814 words)

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