Rapid sequence induction

And failure to protect the airway occurs when a patient has altered mental status or airway compromise that places them at risk for aspiration.

So rapid sequence intubation, or RSI as I'll be referring to it as, is the preferred approach in many emergency situations.

It involves rapid administration of an induction agent followed by an immediate paralytic.

And the goal here is to maximize first-pass success while minimizing complications such as aspiration, hypoxemia, hemodynamic instability, and airway trauma.

And while higher doses may theoretically provide better intubating conditions, this medication at higher doses would lead to longer term paralysis for patients.

For rocuronib specifically, several dosing strategies are used clinically within practice.

So lower doses around 0.6 mg per kg may be appropriate for more routine paralysis, for example, patients who are in the OR getting a procedure, while doses around 1 to 1.2 mg per kg are often used for RSI.

And some literature is even suggesting doses as high as 1.5 mg per kg, hence why the importance of maybe kind of doing this talk and looking at this trial.

We have Haley Snodgrass, a PGY2 emergency medicine resident at New York Presbyterian.

She'll be presenting a journal club on propofol versus ketamine in rapid sequence intubation in critically ill patients.

So I'll start with just some background on the subject.

So rapid sequence intubation or RSI in critically ill patients.

This is a high-risk procedure with a narrow hemodynamic margin.

So RSI combines pre-medication, an induction agent, and neuromuscular blockade, as I'm sure a lot of us are familiar.

Before we get started, make sure to follow the NYSORA podcast on Spotify so you never miss an episode.

Today, we're discussing a 2026 anesthesiology study by Marcus and colleagues examining how rapid sequence induction, RSI, is actually being performed in the operating rooms across the United States.

Using data from more than 9,000 cases, the authors identified a major shift from succinylcholine toward rocuronium alongside increasing use of sorghumidex.

They also found considerable variation in techniques such as cricoid pressure and video laryngoscopy.

And for this episode, we used Maya, the AI built into the NYSORA Anesthesia Assistant app to help us summarize and analyze the study.

I will also share my clinical perspective on what these findings mean for everyday anesthesia practice.

We also spoke with one of the authors, Dr. Marcus, about what motivated them to study and how clinicians should interpret their findings and where the RSI practice may be heading next.

So let's get