Rapid sequence induction and intubation: does it reduce the risk of aspiration?

Pulmonary aspiration of gastric contents during induction of general anesthesia is a rare but potentially lethal complication. For patients considered at high risk for aspiration, rapid sequence induction and intubation (RSII) has long been considered the standard of care to facilitate rapid endotracheal intubation and minimize the risk of aspiration. Its efficacy has been brought into question in recent years, as clinical trials have failed to demonstrate a decrease in the incidence of aspiration or any mortality benefit. Furthermore, there is a great deal of variation in the practice of RSII, and controversy surrounds the evidence for many of the steps considered integral to RSII. In this review, we analyze the role of RSII in reducing the risk of aspiration, and examine many of the components of RSII, including the ideal drug and dose of induction agent and neuromuscular blocking agent, the avoidance of manual mask ventilation, and controversies regarding the use of cricoid pressure. Keywords: rapid sequence induction; cricoid pressure; Sellick's maneuver; aspiration; Mendelson's syndrome. Received: October 10, 2012; Accepted: December 27, 2012; Published: April 11, 2013 Corresponding Author: Alexander Zlotnik, MD, PhD, Department of Anesthesiology and Critical Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel. E-mail: zlotnika@bgu.ac.il .