Current Controversy in RSI

A review article in Anesthesia and Analgesia provides a summary of the literature surrounding RSI controversies.

  • Should a pre-determined dose of induction drug be given or should it be titrated to effect prior to giving suxamethonium?
  • Should fast acting opioids be coadministered to blunt the pressor response?
  • What is the optimal dose of suxamethonium?
  • Should defasciculating doses of neuromuscular blocking drugs be given?
  • What is the ‘priming’ technique with rocuronium and is it necessary?
  • Is it really bad to bag-mask ventilate the patient after induction prior to intubation? Which patients might this benefit?
  • Should patients with full stomachs be anaesthetised sitting up, supine, or head down?
  • Is cricoid pressure a good or a bad thing?

Not surprisingly the jury is still out on these, which is of course why they remain ‘controversies’. The review article provides a readable, interesting, and up to date summary of the evidence to date.

Rapid Sequence Induction and Intubation: Current Controversy
Anesth Analg. 2010 May 110(5):1318-25