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Rapid sequence induction

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Rapid sequence induction describes the quick but controlled advance from induction to maintenance in patients with a high risk of vomiting or regurgitation, e.g. in non-fasted patients, those with hiatus hernia, those with gastrointestinal disturbance and in pregnant females.

The steps are:

  • give the conscious patient a 100% oxygen mixture for 3-4 minutes before induction; this provides as much time as possible for intubation by replacing 21% oxygen in the lung with 100%
  • begin to apply intravenous induction agent
  • apply cricoid pressure - the Sellick manoeuvre
  • give a short-acting muscle relaxant intravenously
  • intubate the patient with an endotracheal tube, ensure its position and inflate to prevent regurgitation
  • release cricoid pressure
  • start volatile agent anaesthetic with oxygen

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