Rapid sequence induction

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