Rapid sequence intubation. The current state of knowledge

Rapid sequence intubation is a widely practiced method for handling the airway during anaesthesia induction in patients with gastric problems or those susceptible to regurgitation or aspiration. Preparation involves gathering essential equipment and medications for emergency intubation, including oxygen, suction, bag-valve mask, laryngoscope, endotracheal tubes with stylets, resuscitation gear, and rescue tools. Despite its consistent use for over five decades, debates persist regarding the efficacy of specific elements of the method, such as cricoid pressure and the assessment of fasting in urgent surgical cases. The absence of standardised rapid sequence intubation techniques and universally accepted guidelines has resulted in discrepancies in published data. Cricoid pressure, also known as the Sellick manoeuvre, is a controversial element of rapid sequence intubation that has both supporters and critics. While it has been used for decades and is recommended by many countries to prevent pulmonary aspiration during anaesthesia, recent research has raised questions about its effectiveness. In patients undergoing emergency surgery, ultrasound of the gastric antrum may help evaluate the size of gastric contents in order to minimise the risk of aspiration pneumonia. Techniques and variants of anaesthetic induction in the rapid sequence intubation algorithm should be adapted to a wide range of clinical groups – particularly in children, obese patients and pregnant women. In paediatric anaesthesia and for obese patients, the traditional rapid sequence intubation with apnoea is not commonly used due to their limited respiratory reserve. Despite its numerous side effects, succinylcholine remains the most frequently employed drug for rapid sequence intubation.