Summary & References: Rapid Sequence Intubation

Summary

• RSI is a complex procedure that require medication to assist with the establish of an advanced airway
• Induction medications are utilized to adequately sedate a patient prior to paralysis and place of an advanced airway
• Patient specific factors should influence which induction agent and paralytic that should be used for RSI
• Post-intubation sedation is a commonly forgotten component of the 7 P’s of intubation and medications should be planned prior to intubation.

References

• Guihard B, Chollet-Xémard C, Lakhnati P, et al. Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial. JAMA. 2019;322(23):2303-2312. doi:10.1001/jama.2019.18254
• April MD, Arana A, Pallin DJ, Schauer SG, Fantegrossi A, Fernandez J, Maddry JK, Summers SM, Antonacci MA, Brown CA 3rd; NEAR Investigators. Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study. Ann Emerg Med. 2018 Dec;72(6):645-653. doi: 10.1016/j.annemergmed.2018.03.042. Epub 2018 May 7. PMID: 29747958.
• Tran DTT, Newton EK, Mount VAH, Lee JS, Mansour C, Wells GA, Perry JJ. Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review. Anaesthesia. 2017 Jun;72(6):765-777. doi: 10.1111/anae.13903. PMID: 28654173.
• Patanwala AE, Erstad BL, Roe DJ, Sakles JC. Succinylcholine Is Associated with Increased Mortality When Used for Rapid Sequence Intubation of Severely Brain Injured Patients in the Emergency Department. Pharmacotherapy. 2016 Jan;36(1):57-63. doi: 10.1002/phar.1683. PMID: 26799349.
• Patanwala AE, Stahle SA, Sakles JC, Erstad BL. Comparison of succinylcholine and rocuronium for first-attempt intubation success in the emergency department. Acad Emerg Med. 2011 Jan;18(1):10-4. doi: 10.1111/j.1553-2712.2010.00954.x. Epub 2010 Dec 23. PMID: 21182564.
• Weiss JH, Gratz I, Goldberg ME, Afshar M, Insinga F, Larijani G. Double-blind comparison of two doses of rocuronium and succinylcholine for rapid-sequence intubation. J Clin Anesth. 1997 Aug;9(5):379-82. doi: 10.1016/s0952-8180(97)00065-2. PMID: 9257203.
• Smith CE, Kovach B, Polk JD, Hagen JF, Fallon WF Jr. Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium. Air Med J. 2002 Jan-Feb;21(1):26-32. doi: 10.1067/mmj.2002.121713. PMID: 11805764.
• Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology. 1993 Nov;79(5):913-8. doi: 10.1097/00000542-199311000-00007. PMID: 7902034.
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• Brown CA, Walls RM. (2017). Airway. In: Walls, Ron M., Robert S. Hockberger, and Marianne Gausche-Hill. Rosen’s Emergency Medicine : Concepts and Clinical Practice / [edited by] Ron M. Walls, Robert S. Hockberger, Marianne Gausche-Hill. Ninth edition. Philadelphia, PA: Elsevier, 2018. Print.
• Neuromuscular Blocking Agents. In: Butterworth IV JF, Mackey DC, Wasnick JD. Butterworth IV J.F., & Mackey D.C., & Wasnick J.D.(Eds.),Eds. John F. Butterworth IV, et al.eds. Morgan & Mikhail’s Clinical Anesthesiology, 6e. McGraw Hill; 2018. Accessed September 3, 2021.
• Hibbs RE, Zambon AC. Hibbs R.E., & Zambon A.C. Hibbs, Ryan E., and Alexander C. Zambon.Nicotine and Agents Acting at the Neuromuscular Junction and Autonomic Ganglia. In: Brunton LL, Hilal-Dandan R, Knollmann BC. Brunton L.L., & Hilal-Dandan R, & Knollmann B.C.(Eds.),Eds. Laurence L. Brunton, et al.eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e. McGraw Hill; 2017. Accessed September 3, 2021. 
• Mace SE. Challenges and advances in intubation: airway evaluation and controversies with intubation. Emerg Med Clin North Am. 2008 Nov;26(4):977-1000, ix. doi: 10.1016/j.emc.2008.09.003. PMID: 19059096.
• Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother. 2014 Jan;48(1):62-76. doi: 10.1177/1060028013510488. Epub 2013 Nov 4. PMID: 24259635.