Rapid Sequence Induction
Reference Steps of RSI NPO time
ผศ.พญ.ปฐมพร ปิ่นอ่อน MED CMU Updated : Jan 2016
  1. เปิด IV 2 เส้น, Monitor EKG, Pulse oximetry, Capnopraghy
  2. เตรียม Suction, Ambulatory bag, Blade, Tube
  3. Preoxygenation (ไม่ทำ positive pressure ventilation)
    • Tidal volume breathing : 100% O2 High flow (8-10 LPM) for 5-10 mins
    • Vital capacity breathing : (EMER) 100% O2 High flow (8-10 LPM) for 4 - 8 breaths in 30 - 60 secs
  4. Induction
    • if Success : Loss of eye lash reflex,
  5. Muscle relaxant
  6. Cricoid pressure (Sellick's maneuver)
  7. Intubation + blow cuff
  8. Check tube
  9. Release cricoid pressure

Clear liquid (< 2 mL/Kg) 2 hrs
Breast milk 4 hrs
Infant formula 6 hrs
Light meal 6 hrs
Regular meal 8 hrs
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Ideal BW


Induction (sedative agents)
Etomidate
stroke head injury seizure coronary shock Non-Barbiturates
Dose 0.2 - 0.3 mg/Kg IV
Onset 20 - 40 secs
Duration 8 - 15 min
Coution
  • No analgesic effect
  • Bradyarrhythmias
  • Massecter spasm
  • Adrenal suppression
Advantage
  • Rapid onset
  • Short duration
Propofol
bronchospasm seizure Non-Barbiturates
Dose
  • 1 - 2.5 mg/Kg IV (ADULT)
  • 2 - 4 mg/Kg IV (PED)
Onset 20 - 40 secs
Duration 5 - 10 min
Coution
  • Apnea
  • Hypotension
  • No anagesia
  • Pain on injection
  • แพ้ไก่ แพ้ไข่ ใช้ไม่ได้
Advantage
  • Bronchodilation
  • Potent Anti-convulsant
  • Anti-emetic
  • Decrease ICP
Fentanyl
Non-Barbiturates
Dose 3 - 8 mcg/kg IV
Onset 1 - 2 mins
Duration 20 - 30 mins
Coution
  • Bradyarrhythmias
  • Massecter spasm
Advantage
  • Reversible anagesia
Midazolam (Dormicum®)
Benzodiazepines Non-barbiturates
Dose 0.1 - 0.3 mg/Kg IV
Onset 30 - 60 secs
Duration 15 - 30 mins
Coution
  • Bradyarrhythmias
  • Massecter spasm
Advantage
  • Rapid onset
  • Short duration
Diazepam (Valium®)
Not recommended for RSI. Non-barbiturates
Dose 0.3 - 0.6 mg/Kg IV
Onset 20 - 40 secs
Duration 15 - 30 mins
Coution
  • Not recommended for RSI.
  • Apnea
  • hypotension
  • No anagesia
Advantage
  • Anti-convulsant
  • Anti-emetic
  • Decrease ICP
Ketamine
stroke head injury bronchospasm shock Non-barbiturates
Dissociative anesthesia
Dose 1 - 2 mg/Kg IV
Onset 45 - 60 secs
Duration 10 - 20 mins
Coution
  • ห้ามให้ในผู้ป่วย Bradyarrhythmias, Ischemic heart disease , vascular aneurysm, hypotension
  • Massecter spasm
Advantage
  • Reversible anagesia

May be an excellent induction agent for patients with bronchospasm, septic shock, AND hemodynamic compromise.

Thiopental
Barbiturates
Dose 3 - 5 mg/Kg IV
Onset 20 - 40 secs
Duration 5 - 10 mins
Coution
  • Apnea
  • hypotension
  • No anagesia
  • Vasculitis
Advantage
  • Decrease ICP
  • Anti-convulsive
Muscle relaxant
Succinylcholine
Depolarizing agent Short acting
Dose 1.0 - 1.5 mg/Kg IV
Onset 45 - 60 secs
Duration 5 - 9 mins
Coution
  • Bradyarrhythmias
  • Massecter spasm
Advantage
  • Rapid onset
  • Short duration
Rocuronium
Non-depolarizing agent Intermidiate acting
Dose 0.6 - 1.0 mg/Kg IV
Onset 1 - 3 mins
Duration 35 - 75 mins
Coution
  • Tachycardia
Advantage
  • Reversible
Cisatracurium
Non-depolarizing agent Intermidiate acting
Dose 0.15 - 0.2 mg/Kg IV
Onset 2 - 3 mins
Duration 40 - 75 mins
Coution
  • Tachycardia
Advantage
  • Reversible