Patients at risk of aspiration (e.g. emergency surgery, incomplete gastric emptying) require a rapid sequence intubation.
An IV induction agent is given through an IV line with fast running fluids, immediately followed by a rapidly acting muscle relaxant.
Cricoid pressure is applied and then intubation proceeds.
The rapid onset of action enables the time to intubation to be short enough to avoid mask ventilation, as this can result in gastric insufflation and aspiration of gastric contents.
- Suxamethonium, 1–1.5 mg/kg, IV. (See : Depolarising muscle relaxants).
- Preferred agent as, in the event of a failed intubation, it wears off quickly enabling spontaneous respiration to resume.
- Contraindications to suxamethonium
- Congenital and acquired medical conditions associated with severe, potentially lethal suxamethonium-induced hyperkalemia.
- Malignant hyperthermia.
If suxamethonium is contra-indicated, consider:
- Rocuronium, 0.9 mg/kg, IV.
- Duration +/- 60 minutes.
Sub-optimal conditions for intubating and prolonged effect can be problematic in the event of a difficult or failed intubation and if the procedure is short.