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Rapid sequence induction and intubation (RSII) for anesthesia

Lauren Berkow, MD
Section Editor
Carin A Hagberg, MD
Deputy Editor
Marianna Crowley, MD


Rapid sequence induction and intubation (RSII) for anesthesia is a technique designed to minimize the chance of pulmonary aspiration in patients who are at higher than normal risk. The usual, nonrapid sequence of induction and intubation for anesthesia consists of administration of an induction agent, proof of the ability to mask ventilate, administration of a neuromuscular blocking agent (NMBA), and endotracheal intubation once paralysis is achieved, usually approximately three minutes after induction. Since induction of anesthesia results in loss of airway protective reflexes, pulmonary aspiration is a risk during the interval between loss of consciousness and inflation of the cuff of the endotracheal tube.

The components of RSII are designed to protect the airway with a cuffed endotracheal tube as quickly as possible after induction, while reducing the chance of passive or active regurgitation. An essential goal of RSII is the achievement of adequate depth of anesthesia, and, most often, paralysis, for laryngoscopy, to prevent coughing, straining, and active vomiting with airway manipulation.

While RSII is a departure from the usual practice of induction of anesthesia, the equivalent method of rapid airway control, often called "rapid sequence intubation" (RSI), is the most commonly used method of controlling the airway in the emergency room.

This topic will discuss the components, techniques, and medications used for RSII for anesthesia. Preoperative fasting guidelines, airway management for induction of anesthesia, rapid sequence intubation in the emergency department, and medications used for induction of anesthesia are discussed more fully separately. (See "General anesthesia: Induction" and "Preoperative fasting guidelines" and "Airway management for induction of general anesthesia" and "Rapid sequence intubation for adults outside the operating room".)


General indications — Rapid sequence induction and intubation (RSII) should be considered for the patient who is at increased risk of aspiration with induction of anesthesia. This includes the patient with a full stomach, gastrointestinal pathology, increased abdominal pressure, or pregnancy after 20 weeks gestation (table 1):

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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2017.
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