Anesthesia for emergency surgery

Question 1

What is Rapid sequence induction

Answer 1

Rapid sequence induction and intubation (RSII) for anesthesia is a technique designed to minimize the chance of pulmonary aspiration in patients who are at higher than normal risk.

Question 2

What are the indications for RSI

Answer 2

1. Patients with a full stomach
   -emergency surgery
   -not follow the fasting guidelines
   -sustained trauma regardless of last oral intake
2. Patients with Gastrointestinal pathology
   -Small bowel obstruction
   -Gastric Outlet obstruction
   -GERD
3. Increased intraabdominal pressure
   -Obesity
   -Ascites
   -Pregnancy >20weeks

Question 3

During RSI premedication, drug such as anxiolytics are given, why?

Answer 3

For patients who are hemodynamically stable, a benzodiazepine (eg, midazolam up to 1 to 2 mg IV) may be administered to reduce anxiety

Question 4

To prevent vagal response(due to succinylcholine and airway manipulation) especially in children which drug is administered.

Answer 4

Atropine

Question 5

Why is preoxygenation important?

Answer 5

All patients presenting for general anesthesia should be preoxygenated with 100 percent oxygen to increase oxygen reserve and provide additional time to secure the airway.

Question 6

How is preoxygenation done

Answer 6

Preoxygenation is administered for three minutes of normal tidal volume breathing, for eight deep breaths over one minute, or until the fraction of expired oxygen is over 90 percent.

Question 7

What is the significance of applying cricoid pressure (Sellick Maneuver) during induction?

Answer 7

To prevent regurgitation

Question 8

When do we release the cricoid pressure

Answer 8

The trachea is intubated
The cuff inflated
The correct position of the tube is confirmed

Question 9

Why are lungs not ventilated during RSI

Answer 9

The lungs are not ventilated during RSI; because it will further reduces barrier pressure and predisposes patient to risk of regurgitation and aspiration