Comments on: RSI…How

By: Felipe Urdaneta

Felipe Urdaneta — Wed, 23 Sep 2009 13:36:00 +0000

I agree with you, and would like to hear what our OB colleagues say.

By: Nikolaus Gravenstein

Nikolaus Gravenstein — Wed, 23 Sep 2009 12:27:56 +0000

i am a fan of routine use of modified rsi. the cricoid prevents gastric insufflation and offers osme protection for even the fasted patient who still has something in their stomach. regardless of full stomach concern or not i gently ventilate. this buys time and alerts the operator at earliest possible moment that yes there is a maskable airway which is reassuring or allows early identification that the airway is not perfect and then m,aneuvers can be initiated to establish ventilation long before desaturation begins to make its presence known. i think it really shifts moving to alternate plan for airway mgmt earlier than if modified rsi mask ventilation werent used and is therefore safer. there are plenty of data that properly applied cricoid protects airway during gentle ventilation. perhaps the focus should be on the skill of the person applying the cricoid. if its not a trained colleague you would be surprised at the answers you get when you ask a circulating nurse what their goal is and how firmly the apply pressure and even where they apply the pressure.

By: Felipe Urdaneta

Felipe Urdaneta — Mon, 22 Jun 2009 18:41:48 +0000

Unfortunately I do not know if Mark reads the blog. I am more inclined to “yes” can ventilate provided the pressure is monitored and limited to 20 ccm H20, however, i have seen we get a bit stronger when the chips are down and I have seen occasional high pressures when we ventilate prior to the fasciculations or we wait for the NDA to act. This is a topic that the Society of airway management has not been able to come to an agreement because of what you say: lack of evidence.. but we do have plenty of opinions.

By: Tammy Euliano

Tammy Euliano — Mon, 22 Jun 2009 18:23:20 +0000

I’ll be interested to see what Mark Rice offers with regard to Cricoid Pressure. I was trained in the “don’t ventilate” camp…both for aspiration reasons, and b/c in virtually all cases, regardless you’re going to push the Succ (whether or not you can mask ventilate). Maybe more impt if considering Roc. These places where “standard of care” exists and EBM is lacking (not negative, just lacking), pose a problem for medico-legal issues I’d think…perhaps Dr. Kirby has an opinion here?