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-» Rapid Sequence Induction ( Cricoid Pressure ) selick maneuver

How are you doing ladies and gentlemen ?

I haven't written any topics since a long time .. today I am goona talk about " Rapid Sequence Induction " which is an important part in anaesthesia .. let us discuss this topic
briefly



-- Principles Of Rapid Sequence Induction --

is a method of inducing anesthesia in a specific group of patients. On induction of anaesthesia , the lower esophageal sphinctor relaxes which that increases the risk of aspiration. of stomach contents to the lungs. There is a group of patients who are at risk of aspiration :
- Recent meal or unknown time of last meal.
- Delayed stomach emptying due to opioids , pain and alcohol.
- Increases gastric reflux dut to obesity , gastroesophageal reflux disease or pregnancy.

Rapid sequence induction aims to achieve rapid induction and intubation without ventilating the lungs and stomach thereby producing risk of aspiration

-- Preparation Of Equipment --

- Laryngoscopes : Straight and curved blades and McCoy.
- Selection of oropharengeal airways.
- Selection of endotracheal tubes.
- LMA .. Laryengeal Mask Airway.
- Bougie.
- Endotreacheal tube conncted to inflating syringe
- Suction under the pillow
- Tape to secure the tube.
- Magill forceps.
- Gel and swabs.


-- Preparation Of Drugs --
Commonly induction ..

we use Thiopentone 500 mg diluated with water in 20 ml syringe to be 25 mg per ml .. if it is not avaliable .. we use Propofol 1 % 10 mg per ml in 20 ml syringe
Muscle relaxant ; the common one is Suxmethonium " scoline " 100 mg in 2 ml .. if it is not avaliable .. use rocuronium " esmeron " 50 mg in 5 ml
Resuscitation drugs like " ephedrine - atropine and ****raminol " have to be standby in case of cardiovascular collapse.


-- Preparation Of Patient --

The procedure should be explained to the patient including the application of cricoid pressure .. establish IV access .. establish monitor " ECG - BP - Pulse oximeter and capnogragh or end tidal CO2 "

-- Procedure Of Rapid Sequence Induction --

Preoxgenate the patient for 3 minutes or more with mask. Just before induction cricoid side identified. Start IV indction ethier thiopentone or propfol followed immediately by suxmethonium or rocuronium .. wait 60 seconds and then intubate. The important point is that don't release your hand in the cricoid and use the other hand to give the anaesthetist the equipment which he needs. Once intubated .. confirm the placement of tube ethier by observing the end tidal CO2 or looking at the chest. Cricoid pressure can be released when the anaesthetist says it.

-- Identification And Application Of Cricoid Pressure --

Cricoid pressure should be done by qualified person .. because increasing or decreasing in pressure may lead to complications .. most complicatins are odema or rapture of esophagus. Crcoid cartilage can be identified by palpating adam's apple going down until you feel rigid cartilage. Use index and thumb to apply cricoid pressure.
The application of cricoid pressure is to minimize aspiration by occluding esophagus against cervical vertebrae