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In anaesthesia and 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 [1] – is a special process for endotracheal intubation that is used where the patient is at a high risk of pulmonary aspiration.
Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which nitrous oxide or volatile anesthetics may be administered. General anesthetic agents, opioids, and neuromuscular-blocking drugs may diminish or even abolish the respiratory drive.
Tracheal intubation, often simply referred to as intubation, is the placement of a flexible plastic or rubber endotracheal tube (ETT) into the trachea to maintain an open airway, allow for effective ventilation, protect the airway from aspiration (when a cuffed ETT is used), and to serve as a conduit through which to administer inhaled anesthetics.
ROTIGS is a transoral appliance that facilitates awake transoral bronchoscopic intubation, laryngoscopy, bronchoscopy, and esophagoscopy. Rotigs consists of a mouthpiece, bite block, and guidance tube. The mouthpiece and integral bite block keeps the device centered and allows a midline bronchoscopic approach to the larynx.
The presence of an endotracheal tube and mechanical ventilation alone are not indications of continuous sedation and coma. Only certain conditions such as intracranial hypertension, refractory status epilepticus, the inability to oxygenate with movement, et cetera justify the high risks of medically induced comas.
Spinal anaesthesia is the technique of choice for Caesarean section as it avoids a general anaesthetic and the risk of failed intubation (which is probably a lot lower than the widely quoted 1 in 250 in pregnant women [3]). It also means the mother is conscious and the partner is able to be present at the birth of the child.