Because of its fast onset, succinylcholine is the most commonly used neuromuscular blocking drug in RSI. Survey on the current management of rapid sequence induction in Germany. Protecting the patient's airway is of paramount importance in the induction of general anesthesia. Rapid Sequence Induction is a skill that all practitioners who work in the anaesthetic area should know how to perform. This combination of drugs may be a useful alternative, if succinylcholine needs to be avoided, for modified rapid-sequence induction. Induction Rapid Sequence Induction (RSI) The rationale for RSI is a perceived reduction in the risk of pulmonary aspiration in patients considered “at risk,” however the evidence behind this has recently (and appropriately) been questioned [Neilipovitz DT. • Equipment and Drugs checked, including suction. 1 Modified Rapid-Sequence Induction. The aim of the trial was to assess how rapidly spontaneous ventilation could be re-established after RSII. RSI is a well-established technique in anesthesia practice. Absolutely critical – more so than intubation, because if you can mask someone, you can get them oxygen and remove CO2. report an international survey of 10,003 anaesthetists and 16 airway experts on preferences for clinical practices associated with rapid sequence intubation (RSI) 1.For a hypothetical patient with intestinal obstruction requiring RSI, the head‐up or ‐down position was preferable, as was nasogastric tube insertion and … Key words: Modified rapid-se-quenceinduction,preoxygenation, cricoidpressure,positive-pressure ventilation. Fitting 3 fingers in an open mouth between upper and lower incisors. Fitting 3 fingers between the edge of the chin and the hyoid bone. 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 [1, 2]. Etomidate is the sedative-hypnotic drug that is most often used in rapid sequence intubation, but its use has been challenged because it can cause a reversible adrenal insufficiency by dose-dependent inhibition of 11β-hydroxylase. Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. Rapid sequence intubation (RSI) is a standard ED procedure in both community and university hospitals. Having identified that rocuronium at 0.6–0.7 mg.kg −1 is essentially a sub-therapeutic dose for rapid sequence intubation, I question whether it makes sense to then include this group in sub-analyses for standard vs. modified emergency participants (emergency department and ICU) and different induction agents. Hyoid-mental distance measurement, and base of … High flow nasal oxygen (HFNO) application has the potential advantage over facemask pre-oxygenation of being continually administered during the apnoea period. Treatment effect was measured using risk ratios with 95% confidence intervals. Rapid sequence induction (RSI) is the optimal basic technique to intubate Consensus hypotensive trauma patients (see Appendix B on p.8). Renal failure with hyperkalaemia etc. o Cricoid pressure. Optimizing each detail increases the likelihood of success. via spontaneous breathing or supported ventilation) to avoid exacerbation of coexistent acidaemia. Analysis was performed on an intention-to-treat basis. Plastic single-use laryngoscope blades are inexpensive and carry a lower risk of infection compared with metal reusable blades, but their efficiency during rapid sequence induction remains a matter of debate. A modified rapid sequence intubation (RSI) approach is usually preferred in shocked patients, including: use of low dose, titrated induction agents to avoid haemodynamic compromise. In 1958, aspiration was credited as the largest cause of anaesthesia-related death by Snow and Nunn. In current clinical practice, a number of modifications have been made to the traditional RSI technique (Figure 1). Modified RSI maximize oxygen store of a patient. Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway. Normal vs. Rapid-Sequence Induction Normal Induction. The combination of etomidate and s-ketamine for anaesthesia induction produces mostly excellent intubating conditions after 60 s using only 0.6 mg kg-1 of rocuronium. In advanced airway management, rapid sequence induction (RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) or as crash induction – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration.It differs from other techniques for inducing general anesthesia in that … MATERIAL AND METHODS:An orotracheal intubation procedure was performed in a total of 267 patients by direct laryngoscopy using an … Statistics. Sugammadex reignited the anaesthesia community's interest in replacing suxamethonium. Can J Anaesth 54: 748, 2007]. ... a different blade) or a modified technique (for example, preforming a stylet). Based on their recent survey, Ehrenfeld et al. Rapid sequence induction (RSI) remains the technique of choice for minimizing this risk. • Pharmacologic sedation and paralysis are induced in rapid succession to quickly and effectively perform laryngoscopy and tracheal intubation. Controlled rapid sequence induction and intubation - An analysis of 1001 children. The combination of etomidate and s-ketamine for anaesthesia induction produces mostly excellent intubating conditions after 60 s using only 0.6 mg kg-1 of rocuronium. We conducted a non-systematic review of literature pertaining to key … 0-3 minutes: Pretreatment. The proportion of excellent intubating conditions created during standard or modified rapid sequence intubation comparing rocuronium with succinylcholine. In the meantime, cricoid pressure was first described in 1961 and in 1970 the traditional rapid sequence induction was described by Stept and Safar [3,4]. In the prehospital and military environments, there is an increasing awareness of the benefits of standardised practice and checklists. Department of Anesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, India. Approach the patient with 9 Ps. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. 1 identified 3 components of the “modified” rapid sequence induction and intubation (RSII) technique: (1) oxygen administration before induction, (2) the use of cricoid pressure (CP), and (3) an attempt to ventilate the patient’s lungs before securing the airway. A priori subgroup analyses for the outcome of excellent intubation conditions compared the following groups: standard rapid sequence intubation vs. modified rapid sequence intubation; induction agent; use vs. non-use of an opioids; doses of rocuronium (0.6, 0.9, or 1.2 mg.kg −1); adults vs. children; and emergency intubations. for rapid sequence induction. Rapid sequence induction. With the introduction of new drugs and equipment in recent years, a wide variation in this technique has been used. Abstract Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. Snow RG, Nunn JF. o Suction ready The term ‘rapid sequence induction’ emphasises the use of a sequential technique in achieving rapid intubation by minimising the time delay between loss of airway reflexes and tube placement. Regurgitation may occur in patients undergoing sedation due to medication side effects, an increase in gastric pressure, or loss of lower esophageal sphincter tone if sedation is too deep. Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. Intravenous induction of anaesthesia, with the application of cricoid pressure, is swiftly followed by the placement of an endotracheal tube (ETT). In anesthesia, the goal of rapid sequence induction is to induce anesthesia while using a rapid sequence approach to decrease the possibil-ity of aspiration. Rapid sequence induction in the emergency department by emergency medicine personnel. A crucial component of developing a standardised protocol is the selection of induction agents. This post explores what might seem like a trivial detail: the ideal order of administration of rocuronium and ketamine for rapid sequence intubation (RSI). Article Google Scholar 19. Current literature supports rapid sequence induction with minimal or no manual positive pressure ventilation is preferred over standard induction techniques.7which causes coronavirus disease 2019 (COVID-19,8 The choice of muscle relaxant during RSI is primarily determined by a need for a rapid onset of quality intubating conditions. In patients undergoing rapid sequence anaesthesia induction, does the use of cricoid pressure vs. a sham procedure, prevent pulmonary aspiration? • This assumes that the patient does not have a “Full Stomach” and that the patient does not have a known or suspected “difficult airway”. 2012;115(1):95–101. However, there is currently no standard definition for a modified RSII. Anesthesiology (February 2010) Background: Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. The difference between success and failure hinges on details. for rapid sequence induction remains controversial. This is called modified rapid sequence. The role of Sellick’s maneuver in rapid sequence induction is widely debated now. However, there is currently no standard definition for a modified RSII. Rapid sequence induction. In advanced airway management, rapid sequence induction ( RSI) – also referred to as rapid sequence intubation or as rapid sequence induction and intubation ( RSII) – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration. Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. Minerva Anestesiol. This is when pressure is applied to the cricoid cartilage to occlude … With emergency RSI, the goal is to facilitate intubation with the addi- ... modified when appropriate to … Background: Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. A modification of this technique is implemented in certain clinical circumstances. However, there is currently no standard definition for a modified RSII. Modified Rapid Sequence Induction. Rapid sequence induction (RSI) of critically ill patients outside of theatres is associated with a higher risk of hypoxia, cardiovascular collapse and death. Fitting 2 fingers between the hyoid bone and the notch of the thyroid cartilage. In the pre-hospital and emergency setting, however, a 1970 Moir modified the technique to include the use of halothane and this reduced the rates of awareness to <1% [3]. Report By: Colin Dibble - Specialist Registrar in Emergency Medicine Search checked by Margaret Maloba - Locum Consultant; Institution: North Manchester General Hospital Date Submitted: 2nd August 2005 Date Completed: 6th January 2006 Last Modified: 22nd … IV MICHAEL TRYBA. 0 + 20-30 seconds: Protection and Positioning. (1959). To the Editor. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. We hypothesized that the time period from tracheal intubation to spontaneous ventilation would be shorter with rocuronium–sugammadex than with … Treatment effect was measured using risk ratios with 95% confidence intervals. Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia: A Multicenter Cluster Randomized Study. Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia: A Multicenter Cluster Randomized Study. avoidance of apnoea (e.g. A modification of this technique is implemented in certain clinical circumstances. M allampati score: The more of the throat you can see, the easier it will be. Rapid Sequence Intubation. Anesthesia induction sequence. It is a complex intervention with significant risks and the procedure is often tailored to the individual patients’ requirements [2,3]. Rapid Sequence Intubation (RSI) OVERVIEW Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway. This case scenario is of an adult, non-pregnant patient undergoing a rapid sequence induction. o Pre-oxygenate. This is a common anaesthetic technique in the UK when there is a risk of gastro-oesophageal reflux. Anesth Analg. The most common complications during RSI are hypoxia, particularly in small children weighing 10-19 kg [ 7 ]. ATOTW 331 th– Rapid Sequence Induction (24 May 2016) Page 2 of 8 The above classic method is now very rarely followed in full. To optimize patient outcome and to reduce risk of hypoxia, currently the modified technique of rapid sequence induction/intubation is practiced in certain clinical circumstances [2,3]. If during rapid-sequence induction, there are difficulties in securing the airway and oxyhemoglobin desaturation occurs, gentle positive pressure ventilation may be used while maintaining cricoid pressure. Modified 3-3-2 to facilitate best blade selection. There are a few induction agents, but the big ones to consider are etomidate, ketamine, and propofol. Modified rapid sequence induction and intubation: a survey of United States current practice. Rapid sequence induction (RSI) of critically ill patients outside of theatres is associated with a higher risk of hypoxia, cardiovascular collapse and death. 1 Modified Rapid-Sequence Induction RSI is a well-established technique in anesthesia practice. During standard RSI, patients are made apneic and unconscious without establishing the ability to ventilate the lungs. Positive pressure usually is avoided to prevent gaseous distention of the stomach and subsequent pulmonary aspiration in RSI. It involves loss of consciousness during cricoid pressure followed by intubation without face mask ventilation. Report By: Colin Dibble - Specialist Registrar in Emergency Medicine Search checked by Margaret Maloba - Locum Consultant; Institution: North Manchester General Hospital Date Submitted: 2nd August 2005 Date Completed: 6th January 2006 Last Modified: 22nd … • Check all patient monitors. In the prehospital and military environments, there is an increasing awareness of the benefits of standardised practice and checklists. Modified Rapid Sequence Induction. Rapid sequence induction (RSI) is an established method of inducing anaesthesia in patients who are at risk of aspiration of gastric contents into the lungs. The usual, nonrapid sequence of induction and intubation for anesthesia consists of administration of an induction agent, proof of the ability to mask ventilate, administration of a neuromuscular blocking agent (NMBA), and endotracheal intubation once paralysis is achieved, usually approximately three minutes after induction Rapid sequence … It is more commonly used in emergency anaesthesia, although there are times when it will be performed during a routine list. This assessment is likely limited to gross visualization of mouth opening. The sequential administration of an induction agent and neuromuscular blocking agent to facilitate endotracheal intubation; Highest intubation success rate in properly selected cases and superior to sedation alone; Those deeply comatosed or in cardiorespiratory arrest may be intubated without pharmacological assistance A modification of this technique is implemented in certain clinical circumstances. However, there is currently no standard definition for a “modified RSII.” Rapid Sequence Intubation Definition Rapid sequence intubation is the administration of a potent induction agent (anaesthetic) followed by a rapidly acting neuromuscular blocking agent (usually suxamethonium) to induce unconsciousness and motor paralysis patient has a full stomach, and is therefore at risk of aspiration of gastric contents. The … (EKG, NIBP, Oximitry, End-tidal CO2/CO2 detector) Rapid-sequence induction is advised to reduce the duration of the procedure and may be modified by ventilating the lungs before intubation when treating patients in whom even a brief period of. Modified rapid sequence induction with Anesthetics and intermittent ventilation. For those considered to have high risk of aspiration, we were taught or trained to apply either rapid sequence induction/intubation or some forms of modified versions. Complications related sedation are quite similar to those for rapid sequence induction and intubation, although sometimes for different reasons. identify “full-stomach” patients at risk for aspiration of gastric contents describe rationale for use of rapid -sequence induction (RSI) in full-stomach patients explain the historical context of cricoid pressure and current evidence for its efficacy We conducted a non-systematic review of literature pertaining to key … Background. Key message Replacing the native clpP1 gene in the Nicotiana plastid genome with homologs from different donor species showed that the extent of genetic incompatibilities depended on the rate of sequence evolution. Modified rapid sequence induction and intubation: a survey of United States current practice. However, the role of cricoid pressure remains under debate2,3. How: o Rapid hypnotic (thiopentone – highly lipid soluble). Enter sugammadex. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. The role of cricoid pressure is controversial because of the lack of scientific evidence. The 1 In their publication, the … Facemask Ventilation and Preoxygenation Mask Ventilation. 0 + 1 minute: Post-intubation management. For the first time we could not only use rocuronium for a modified rapid sequence induction, but then use sugammadex to reverse the paralysis even faster than suxamethonium could itself wear-off.Several studies showed that sugammadex 16 mg/kg … Etomidate: 0.3 mg/kg IV, quick onset, lasts 3-12 minutes. Definitions Rapid Sequence Intubation: • Describes a sequential process of preparation, sedation, and paralysis to facilitate safe, emergent tracheal intubation. Rapid-sequence induction of anaesthesia with succinyl- choline and orotracheal intubation is an established tech- nique in patients who are at risk of aspiration of gastric contents during anaesthesia. Abstract The plastid caseinolytic protease (Clp) complex plays essential roles in maintaining protein homeostasis and comprises both plastid … 1-4,7-10. The optimal dose of succinylcholine for rapid sequence induction: a systematic review and meta-analysis of randomized trials. Preoxygenation via facemask with 10 mbar PEEP and 8 mbar pressure support. Modified rapid-sequence induction of anesthesia: A survey of current clinical practice Stacey Schlesinger, CRNA, MSN, MBA S t aesv il, N orh C n … Griesdale DE, Liu D, McKinney J, Choi PT. Rapid sequence intubation with administration of a sedative and a paralytic agent is common. Ventilation via anesthetic machine until intubation. Rapid sequence induction (RSI) is a method of achieving rapid control of the airway whilst minimising the risk of regurgitation and aspiration of gastric contents. Rapid Sequence Induction (RSI) of anaesthesia was described in 1970 by Stept and Safar. Rohsbach CB, Wirth SO, Lenz K, Priebe HJ. A modification of this technique is implemented in certain clinical circumstances. Two hundred … An unanticipated difficult airway may arise during rapid sequence induction and intubation (RSII). 0-5 minutes: Preoxygenation. Rapid sequence induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients [1]. INTRODUCTION: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. 5. The ‘classical’ technique of rapid sequence induction (RSI) of anaesthesia was described in 1970. Rapid sequence induction, non-pregnant adult patient, no predicted difficulty. 1 Surprisingly, this remains the case in 2011. Aspiration of gastric air via nasogastric tube at the beginning of laparoscopy. 0 + 45 seconds: Placement. Source: PubMed (Add filter) Published by BMC anesthesiology, 02 March 2020. for the widely accepted standard regimen of succinylcholine for rapid sequence induction (1.0 mg kg- 1) remains unclear. Modification of the traditional RSI may have benefits for individual patients. The term ‘rapid sequence induction’ emphasises the use of a sequential technique in achieving rapid intubation by minimising the time delay between loss of airway reflexes and tube placement. Positive pressure usually is avoided to prevent gaseous distention of the stomach and subsequent pulmonary aspiration in RSI. Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. o Rapid relaxant (suxamethonium classically). Rapid sequence induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients [].It is a complex intervention with significant risks and the procedure is often tailored to the individual patients’ requirements [2,3].In the pre-hospital and emergency setting, however, a simple and standardised RSI protocol may … widely used as part of rapid sequence induction in patients at high risk of aspiration. Rapid sequence induction has no use in pediatric anesthesia. The aim is to intubate the trachea as quickly and as safely as possible. This retrospective analysis is aimed at comparing the effect of classic and modified rapid sequence induction in prevention of gastric content regurgitation in emergency surgery under general anesthesia. Each step of the guideline is described. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. The question: Rocketamine vs. Keturonium A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. E valuate: 3,3,2 rule for an easier intubation. A modification of this technique is implemented in certain clinical circumstances. Statistics. LIVES Mnemonic for Tracheal Intubation. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver … The dose of rocuronium was at least 0.6 mg/kg and succinylcholine was at least 1 mg/kg. randomly allocated to spontaneous breathing maintained induction and intubation group (Group S) and the modi-fied rapid sequence group (Group C). Although succinylcholine is a reliable agent, due to its rapid onset, it has numerous The primary outcome was the incidence of hypoxemia around the intubation period, which was defined as SpO 2 <90% at any time during the induction and 10 min after the endotracheal intuba - tion. Rocuronium versus succinylcholine for rapid sequence induction intubation Diem TT Tran1, Ethan K Newton1, Victoria AH Mount2, ... modified RSI in any age group or clinical setting. Rapid sequence induction in the emergency department by emergency medicine personnel. The bog standard RSI (PreOx x3min, Push Induction agent, chaser of Scoline (The Lord's own muscle relaxant ) with cricoid, and shlonk that snorkel in as soon as fasciculations pass) AND the "Modified Rapid Sequence" The Modified Rapid sequence usually was used in patients who you don't want to give Sux to i.e. Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway the cessation of spontaneous ventilation involves considerable risk if the provider does not … Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management. Backup frequency set at 10/min. Analysis was performed on an intention-to-treat basis. Neuhaus D, Schmitz A, Gerber A, Weiss M. (2013). e … Our department modified the scheme and put it into use in day shift emergency surgery since March 1, 2018. This month in Anaesthesia, Zdravkovic et al. This positive pressure should require <25 cm H2O pressure. Given at the same time or quickly after induction. However, there is currently no standard definition for a modified RSII. Induction of anaesthesia in the foot-down position for patients with a full stomach. Anesth Analg 2012; 115:95. MICHAEL TRYBA Search for other works by this author on: This Site. The method of choice for emergency intubation in the intensive care unit (ICU) is a rapid sequence induction (RSI). The present study was thus planned with the aim of comparing cisatracurium and rocuronium in terms of vocal cord relaxation (intubating conditions), onset time, time to intubation, recovery time from neuromuscular blockade and hemodynamic parameters in patients undergoing general surgical procedures. Nandini Dave. While sugammadex increases the safety of rocuronium use for rapid sequence induction, the evidence does not yet support a wholesale shift from sux to roc-sugammadex. It is important for us not to loose sight of the purpose of the RSI: rapid intubation and airway protection. Search for more papers by this author Zero minutes: Paralysis. In advanced airway management, rapid sequence induction (RSI) - also referred to as rapid sequence intubation or as rapid sequence induction and intubation (RSII) - is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration or impending airway compromise. The proportion of excellent intubating conditions created during standard or modified rapid sequence intubation comparing rocuronium with succinylcholine. During standard RSI, patients are made apneic and unconscious without establishing the ability to ventilate the lungs. Studies examining the effect of cricoid pressure on laryngoscopy and intubation have been contradictory, … A modification of this technique is implemented in certain clinical circumstances. Paediatric Anaesthesia. Moreover, gentle mask ventilation has been recommended in … 0 + 45 seconds: Proof of correct ETT placement. Last Modified: 23rd February 2012 Status: Green (complete) Three Part Question In a [patient undergoing rapid sequence induction in the emergency department] are [rocuronium and suxamethonium similar] at providing [optimal intubating conditions] Clinical Scenario For the patient at risk of regurgitation of stomach contents, the rapid-sequence (crash) induction provides protection, but at the expense of increased stress response to … Hypoxia (most commonly recognised by low oxygen saturations) is a recognised complication of rapid sequence induction, and endotracheal intubation in general. Cricoid pressure refers to digital pressure against the cricoid cartilage, pushing it backwards with the intention of oesophageal compression to prevent aspiration of gastric contents We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants’ airway Background. The authors therefore compared plastic and metal blades during rapid sequence induction in a prospective randomized trial.Methods. Ehrenfeld JM, Cassedy EA, Forbes VE, et al. Has a long history of use in … Initially described as "rapid sequence induction and intubation" in the anesthesiology literature, this term was shortened to rapid sequence intubation by emergency physicians. BACKGROUND:This retrospective study was conducted at a single center in China and aimed to compare rocuronium with succinylcholine for rapid sequence induction intubation in the Emergency Department of a hospital. This combination of drugs may be a useful alternative, if succinylcholine needs to be avoided, for modified rapid-sequence induction. The use of thiopentone by an experienced airway clinician results in the most optimal intubation conditions, but may also result in a significant decrease in blood pressure. 2013;79:716–26. Thus, the implications of rapid sequence induction should be strongly considered prior to induction in any high risk patient. First defined in written protocol and published in 1970, rapid sequence induction/intubation (RSI) technique was aimed to avoid regurgitation, vomiting, or aspiration while performing rapid tracheal intubation on patients with suspected full stomach during induction of general anesthesia or cardiopulmonary resuscitation. Br J Anaesth. After 60 s using only 0.6 mg kg-1 of rocuronium survey, Ehrenfeld et al protect the.! Different reasons RSI, patients are made apneic and unconscious without establishing the to... 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