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Chapter-05 Rapid Sequence Intubation

BOOK TITLE: IAP Textbook of Pediatric ICU Protocols

Author
1. Khilnani Praveen
2. Chirla Dinesh Kumar
3. Shaikh Farhan
ISBN
9789350903704
DOI
10.5005/jp/books/11878_5
Edition
2/e
Publishing Year
2013
Pages
6
Author Affiliations
1. Max Hospitals, Press Enclave, Saket, New Delhi, India, Rainbow Children’s Hospital, New Delhi, India, Madhukar Rainbow Children’s Hospital, New Delhi, India, Pediatric Intensivist, IP Apollo Hospital, New Delhi B-42, Panchsheel Enclave, New Delhi 110017, BLK Superspeciality Hospital, New Delhi, India; PICU Mediclinic City Hospital, Dubai, UAE, for IAP and ISCCM; BLK Super Speciality Hospital, New Delhi, India, BLK Super Speciality Hospital, New Delhi, India, Max and BLK Hospitals, New Delhi, India, BLK Superspeciality Hospital, New Delhi, BLK Superspeciality Hospital, New Delhi, India, Max Hospital, New Delhi, MAX Superspeciality Hospital, New Delhi, Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, e-mail: praveenk@nde.vsnl.net.in, Apollo Hospital, New Delhi, Max Hospitals, New Delhi, India, Pediatric Pulmonology and Critical Care, Max Healthcare Hospitals, Saket, New Delhi and Gurgaon (Haryana)
2. Rainbow Children’s Hospital, Hyderabad, India, Rainbow Children’s Hospital and Perinatal Center, Hyderabad, AP, India, Rainbow Children’s Hospital and Perinatal Center, Hyderabad, Andhra Pradesh, India
3. Rainbow Children’s Hospital, Hyderabad, AP, India, Rainbow Children Hospital, Hyderabad, Andhra Pradesh, India, Rainbow Children’s Hospital, Hyderabad, Andhra Pradesh, India
Chapter keywords
Gastric regurgitation, Bag-mask ventilation, Sellick’s maneuver, Opioids, Aspiration, Cricoid cartilage, Rapid sequence intubation

Abstract

Rapid sequence intubation (RSI) is a technique used to secure the airway in patients who presents with full stomach where gastric insufflation by bag-mask ventilation may cause gastric regurgitation and pulmonary aspiration. RSI is contraindicated in patients who cannot be orally intubated. Main purpose of RSI is to avoid positive pressure ventilation by bag and mask, and prevent gastric inflation in patients at risk of aspiration. Steps involved in RSI are discussed in detail in the chapter. The major steps include preparation, preoxygenation, pretreatment, paralysis with induction, protection and positioning, placement, proof, postintubation management. The choice of paralysis induction agents are based on patient’s clinical condition and agent’s specific attributes and their clinical characteristics are explained in detail here. The major purpose of RSI is to make emergent intubation easier and safer, thereby, increasing the success rate of intubation while decreasing the complications.

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