When you encounter an emergent/ urgent patient requiring an emergency operation, the anaesthetic management has to be modified to reduce perioperative complications. If you require an airway control with an endotracheal tube placement, the airway management technique should be shortened so that you required a shorter time to intubate your patient. In an elective surgical patient, you can administer an induction agent after adequate premedication, check whether or not you can assist a manual ventilation via a facemask, then you become sure that it is safe for him/ her if you cannot put the tube in, finally you can administer an intubating dose of a non-depolarising muscle relaxant to facilitate an intubation, you have to ventilate and oxygenate your patient until the muscle relaxant has its full effect which is normally more than three minutes.
This manual assisted ventilation is not safe for your emergent surgical patient, because it does not ensure you that you have a 100 % pulmonary ventilation without gastric ventilation. Therefore, an airway control in this patient group, you start with a pre-oxygenation with a facemask, you can encourage your patient to hyperventilate or denitogenate by telling him to have a big tidal volume reaching a forced vital capacity, this process requires approximately three minutes, so that your patient can tolerate an apnoea without a need of positive pressure ventilation like an induction of elective patient. Then you induce your patient after premedication with a calcuated induction dose of Thiopental, immediately after an induction dose you administer an intubating dose of suxamethonium/ succinyl choline, and then wait for 60 seconds before putting an endotracheal tube in. While an assistant is giving your patient the drugs, your need another assistant to compress the cricoid cartilage against the vertebral column immediately after beginning the pharmacologic administration. This technique is called "rapid sequence induction with cricoid pressure".
I have a problem downloading the video clip of an RSI with cricoid pressure "Sellick's manuvoure" for a pregnant scheduled for an elective caesarean section to this blog, however, if you are interested in viewing the clip, please have a look at our facebook page, Here.
http://www.facebook.com/photo.php?v=417572734949103&set=o.323333441056624&type=2&theater
This manual assisted ventilation is not safe for your emergent surgical patient, because it does not ensure you that you have a 100 % pulmonary ventilation without gastric ventilation. Therefore, an airway control in this patient group, you start with a pre-oxygenation with a facemask, you can encourage your patient to hyperventilate or denitogenate by telling him to have a big tidal volume reaching a forced vital capacity, this process requires approximately three minutes, so that your patient can tolerate an apnoea without a need of positive pressure ventilation like an induction of elective patient. Then you induce your patient after premedication with a calcuated induction dose of Thiopental, immediately after an induction dose you administer an intubating dose of suxamethonium/ succinyl choline, and then wait for 60 seconds before putting an endotracheal tube in. While an assistant is giving your patient the drugs, your need another assistant to compress the cricoid cartilage against the vertebral column immediately after beginning the pharmacologic administration. This technique is called "rapid sequence induction with cricoid pressure".
I have a problem downloading the video clip of an RSI with cricoid pressure "Sellick's manuvoure" for a pregnant scheduled for an elective caesarean section to this blog, however, if you are interested in viewing the clip, please have a look at our facebook page, Here.
http://www.facebook.com/photo.php?v=417572734949103&set=o.323333441056624&type=2&theater
Updated on 29 Aug 2012
The cricoid pressure application for Rapid sequence induction is usually asked by our team to the medical students in the last summative evaluation hour, because when you are a new graduate doctor, you might be asked to perform this especially here in Thailand where nurse anaesthetists are the main working force in the Kingdom, and anaesthetists are not available at every hospital.
One thing to be kept in mind is that compressing the cricoid would make a flexion move in the next which make a more difficult endotracheal intubation, in order to minimise this, you do have to have a cricoid pressure with a bi-manual technique, meaning that one hand is in front of the neck to compress the cartilage while the other is behind to increase the neck extension to facilitate an intubation.
The cricoid pressure application for Rapid sequence induction is usually asked by our team to the medical students in the last summative evaluation hour, because when you are a new graduate doctor, you might be asked to perform this especially here in Thailand where nurse anaesthetists are the main working force in the Kingdom, and anaesthetists are not available at every hospital.
One thing to be kept in mind is that compressing the cricoid would make a flexion move in the next which make a more difficult endotracheal intubation, in order to minimise this, you do have to have a cricoid pressure with a bi-manual technique, meaning that one hand is in front of the neck to compress the cartilage while the other is behind to increase the neck extension to facilitate an intubation.
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