When performing intubation in a patient not at risk of regurgitation, a non-depolarizing muscle relaxant is normally administered after induction of anaesthesia. There is then a delay of 2-3 min before optimal intubating conditions are achieved and intubation can occur. Bag-mask ventilation must be used during this time to maintain oxygenation.

Question: Why is this technique unsafe in patients at risk of regurgitation?

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When performing intubation in a patient not at risk of regurgitation, a non-depolarizing muscle relaxant is normally administered after induction of anaesthesia. There is then a delay of 2-3 min before optimal intubating conditions are achieved and intubation can occur. Bag-mask ventilation must be used during this time to maintain oxygenation.

Question: Why is this technique unsafe in patients at risk of regurgitation?

Answer:

1. There is a 2-3 min period after induction, and before intubation, during which time the airway is unprotected
2. Positive pressure bag-mask ventilation may insufflate the stomach, increasing intra-gastric pressure and the likelihood of regurgitation

RSI is a technique that addresses these problems.