Introduction
The aim is to rapidly achieve intubating conditions whilst minimising the risk of aspiration to the patient. No current drugs allow the effects to wear off quick enough to prevent many patients from desaturating if intubation cannot be achieved. It is vital to have a strategy if one Can’t intubate, Can’t oxygenate
Standard Procedure
- Position patient in sniffing procedure
- Prepare equipment, drugs, monitoring etc
- Pre-oxygenate
- Rapid administration of anaesthetic agent and suxamethonium
- Administer cricoid pressure
- Continue to hold mask oxygen to provide apneic oxygenation
- Wait for fasciculations to cease
- Laryngoscopy
- Epiglottoscopy
- Visualise vocal cords
- Pass tracheal tube
- Connect tube and ventilate to check position
- Release cricoid pressure
For more detail see the procedure for a Rapid Sequence Induction
Controversies and Advances
- Drug dosing in shocked patients
- Drug timing (Delayed Sequence Induction) in hypoxic patients
- Role of routine use of cricoid pressure in preventing aspiration
- The role of Video Laryngoscopes
- Passive nasal apneic oxygenation during laryngoscopy to prolong time to desaturation following apnea
Further Reading