Leading with Induction or Paralysis in Rapid Sequence Intubation – Putting the Debate to Sleep

by Briana Burbach, PharmD, BCCCP

​Rapid sequence intubation(RSI) is a procedure for emergently securing an airway in patients with respiratory distress or when airway protection is necessary. RSI is usually described as a series of seven steps, often referred to as the “seven Ps”:

1. preparation
2. preoxygenation
3. preintubation optimization
4. paralysis with induction
5. protection and positioning
6. placement with proof
7. postintubation management

Step 4 involves the use of a sedative to produce an unconscious state and a neuromuscular blocking agent (NMBA) to produce paralysis and muscle relaxation. The goal of step 4 is to facilitate optimal conditions for intubation.

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Keywords: Intratracheal Intubation, Goals, Critical Care Hypnotics and Sedatives, Propofol, Etomidate, Ketamine, Midazolam, Rocuronium, Succinylcholine, Apnea, Laryngoscopes, Neuromuscular Blocking Agents, Analgesics, Hypoxia, Paralysis, Muscle Relaxation

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