![]() This may be because little good evidence has been published since the original description to indicate that traditional RSI effectively reduces aspiration or improves patient outcomes. Almost every element of the original technique has been challenged or adapted. ![]() However, in recent years this consensus has rapidly declined and the emergency anaesthesia literature has revealed considerable variation and controversy in how the intervention is delivered. This led to a remarkably consistent approach to emergency anaesthesia for many years and this technique is still widely practiced in many countries. The traditional method describes: denitrogenation of the lungs with 100% oxygen for at least 2 min, induction with a pre-determined dose of thiopentone, application of cricoid pressure, administration of a pre-determined dose of suxamethonium, a period of apnoea with no positive pressure ventilation, tracheal intubation with a cuffed tracheal tube, and the release of cricoid pressure when tube placement is successfully confirmed. It followed the work by Sellick on the use of cricoid pressure to prevent reflux of gastric contents during induction. Rapid Sequence Induction (RSI) of anaesthesia was described in 1970 by Stept and Safar. Rapid induction of anaesthesia and tracheal intubation is used in the management of critically unwell patients to address the long-recognised risk of aspiration of gastric contents and unnecessary morbidity and mortality. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged. The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. ![]() RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. ![]() Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. ![]()
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