Special Considerations in Pediatrics for Rapid Intubation Sequence

Abstract

The rapid intubation sequence (RISS) in children is a fundamental procedure used in emergency situations and pediatric critical care to ensure a safe airway and establish effective mechanical ventilation. This study aims to provide a comprehensive and up-to-date review of SIR in children, focusing on key aspects related to its clinical application. The essential steps of SIR in children are reviewed in detail, including pre-preparation, administration of sedative and muscle relaxant agents, induction of anesthesia, laryngoscopy, insertion of the endotracheal tube, confirmation of proper tube position, and subsequent respiratory support. Anatomic and physiologic differences between children and adults are highlighted, and specific considerations to be taken into account when performing SIR in this vulnerable population are described. In addition, the different drugs used for sedation and muscle relaxation in pediatric RDS are discussed in depth, highlighting dosages, pharmacologic effects, and potential associated complications. The importance of careful selection of appropriate agents and doses based on the child's age, weight, and clinical condition is discussed. It also addresses the use of specific medical equipment in pediatric RDS, such as pediatric laryngoscopes, adapted endotracheal tubes, pediatric videolaryngoscopy devices and capnographs, highlighting their relevance in the accurate visualization of the airway and confirmation of adequate intubation. Finally, the importance of adequate training, clinical expertise and multidisciplinary collaboration in the successful performance of SIR in children is highlighted. Emphasis is placed on the need for continuous monitoring and meticulous evaluation throughout the procedure, as well as the implementation of strategies to minimize risks and potential complications.