Essential Equipment and Medications for Rapid Sequence Intubation

Airway Equipment

The American Society of Anesthesiologists recommends using a video laryngoscope with disposable blades or a direct laryngoscope with standard and short handles, and metallic blades of different sizes for rapid sequence intubation 1, 3
Endotracheal tubes should include uncuffed sizes (2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, and 6.0 mm) and cuffed sizes (6.5, 7.0, 7.5, 8.0, and 9.0 mm) 4
Stylets made of malleable material should be available to shape endotracheal tubes 3
Oropharyngeal airways (sizes 0-5) and nasopharyngeal airways (12F through 30F) should be included in the airway equipment 4
Supraglottic airway devices, such as laryngeal mask airways, should be available as backup airway equipment 1, 3
A disposable flexible video bronchoscope should be available if possible, and a cricothyroidotomy kit should be included for emergency surgical airway 1, 3

A capnography device is essential to confirm correct endotracheal tube placement 3
A pulse oximeter with sensors appropriate for patient size, a cardiorespiratory monitor, and blood pressure monitoring equipment should be used to monitor the patient's vital signs 4

The American Society of Anesthesiologists recommends using etomidate (0.3 mg/kg) or ketamine (1-2 mg/kg) as induction agents for hemodynamically unstable patients 2
Succinylcholine (1-1.5 mg/kg) is recommended as the first-line neuromuscular blocking agent when no contraindications exist, and rocuronium (0.6-1.2 mg/kg) can be used as an alternative 2
Sugammadex should be immediately available in case of a "cannot intubate/cannot oxygenate" scenario when using rocuronium 1, 2

Equipment to facilitate a semi-Fowler position, such as a wedge or pillows, should be available 5, 2
A high-flow nasal oxygen device and non-invasive positive pressure ventilation equipment should be used for preoxygenation, especially for anticipated difficult laryngoscopy 5, 2
A bag-valve-mask resuscitator with appropriate masks and an oxygen source with flow regulators should be included in the preoxygenation equipment 4

A suction device with Yankauer and flexible suction catheters, nasogastric tubes, IV access equipment, and syringes and needles for medication administration should be available 4, 5, 2
A difficult airway trolley with immediate access to all equipment should be organized in a standardized manner 3

The American Society of Anesthesiologists recommends organizing equipment in a standardized manner for quick access and preparing medications in advance with appropriate dosing 1
A checklist should be used to ensure all necessary equipment is present, and daily checks of difficult airway equipment should be performed 3

Inadequate preoxygenation increases the risk of desaturation, and proper technique and medication-assisted preoxygenation should be considered for uncooperative patients 2
Failure to have backup airway equipment immediately available can lead to "cannot intubate/cannot oxygenate" scenarios, and inappropriate medication selection or dosing can cause hemodynamic instability 3, 2
Lack of capnography to confirm tube placement is a significant safety risk, and having a standardized protocol reduces medication redosing and complications 3
The American Society of Anesthesiologists recommends that RSI should be performed by experienced providers, and repeated intubation attempts should be minimized to reduce the risk of complications 1