RSI

Question 1

Which NMB is used in RSI?

Why?

Answer 1

1. Suxamthenonium(succinylcholine)

2. because it is rapid acting, the onset of action is between 30-60 seconds

Question 2

How does cricoid pressure work?

Answer 2

It is when we push on the cricoid ring and compress the oesophagus posteriorly and the patient cannot regurgitate(C6)

Question 3

What can we use instead of Sux if contraindicated(burns/MH)

Answer 3

-We can give rocuronium

Question 4

Why do we do RSI?

Answer 4

To induce anaesthesia to prevent aspiration

Question 5

What is the contra-indication to RSI?

Answer 5

-difficult airway(you need to refer the pt)

Question 6

What are the risk factors for aspiration/regurgitation?

Answer 6

1. laryngeal reflexes
2. decreased lower oesophageal tone
3. increased abdominal pressure
4. delayed gastric emptying

Question 7

What blunts the laryngeal reflexes?

Answer 7

1. GCS<8/15-trauma, head injury, CVA
2. anatomical abnormalities
3. mypathies
4. bulbar and pseudo bulbar palsies- Parkinsons, cerebral pasly

Question 8

What decreases the lower oesophageal tone?

Answer 8

1. hiatus hernia with the hx of GERD
2. pregnancy
3. drugs-caffeine, B2 stimulation, alcohol
4. obesity
5. achalasia, oesophageal strictures

Question 9

What causes an increase in intra-gastric pressure?

Answer 9

• when patient had something to eat
• pregnancy
• morbid obesity
• intestinal haemorrhage

Question 10

What causes delays in gastric emptying?

Answer 10

1. opiates, anticholinergics, pain, fear, active labour, renal failure

Question 11

Why do we need to pre-oxygenate the patient before the RSI?

Answer 11

To buy us more time to intubate

• use oxygen mask
• Make sure the ET02 is more than 90% or wait 3-5 minutes to finally see the results

Question 12

What is another name for applying cricoid pressure?

Answer 12

• Applying sellick maneovre

- provide pressure of 10N and 30-40N when patient has a GCS of<8

Question 13

Which induction agents are ideal?

Answer 13

1. propofol
2. thiopentone
3. etomidate
4. ketamine

Question 14

What do we do after extubation?

Answer 14

1. left lateral, head down/head up position

Question 15

If the patient aspirates what do you do?

Answer 15

1. suction

2. Give supplemental oxygen, PEEP and maybe even IPPV

Question 16

What is the pre-treatment procedure in these patients?

Answer 16

1. maxalon 10 mg
   2.Increase ph: sodium citrate 30 ml for 30 minutes
   PPI- continue if patient on it already
   H2 receptors_ranitidine,cimetidine at least 2 hours prior
   3.

Question 17

What is the sequence for non-Rapid Sequence induction in a patient in theatre?

Answer 17

1. Start off by giving supplemental oxygen with oxygen mask via the breathing circuit
2. You can give extra meds to make sure the intubation process is ubtunded-benzodiazepine, fentanyl, ketamine
3. Then titrate the intravenous induction agent until the patient loses the eyelid reflex(they are asleep)
4. Either LMA or ETT
5. When using them you attach the ventilator and start the IAA
6. Secure the airway with tape
7. close the patients eyes
8. Make sure the fresh gas flow is Fi02 of 30% and more than 1L/min of wash in and <1L/min for maintenance

Question 18

How do you wake the patient up?

Answer 18

1. Stop the IAA
2. Give > 5L of fresh gas flow
3. Gie 80-100% of oxygen
4. suck up the pharyngeal secretions
5. Make sure full muscle strength has come back(give reversal if it hasnt)
6. confirm spontaneous ventilation(3-5 Tidal volume)
7. Confirm whether they are able to protect their airway: with a GCS>8

Question 19

Why do we apply cricoid pressure?

Answer 19

-to ensure that the oesophagus is compressed between the verterbral column and the cricoid

Question 20

Why do we use the cricoid specifically?

Answer 20

The cricoid is the only part that has a complete ring of cartilage because the trachea does not have cartilage posteriorly