In a parturient requiring general anaesthesia for emergency Caesarean section, rapid sequence induction (RSI) differs from non-obstetric RSI primarily in which respect?

• A Succinylcholine is contraindicated in pregnancy and rocuronium must be used
• B Propofol is preferred over thiopentone in obstetric RSI for rapid onset
• C The head-down (Trendelenburg) position is used to prevent aspiration
• D Pre-oxygenation must achieve EtO2 >90% (3–5 minutes tidal volume breathing or 8 vital capacity breaths); cricoid pressure is applied during intubation attempts; and cricoid should be released if it obstructs view ✓

Explanation

Obstetric RSI is modified by: (1) prolonged pre-oxygenation to achieve EtO2 >90% because the gravid uterus reduces FRC by 20% and increased metabolic rate shortens safe apnoea time to <3 minutes; (2) cricoid pressure (Sellick's manoeuvre, 30 N force) to occlude the oesophagus and prevent passive regurgitation of acid gastric contents; however, if cricoid pressure worsens the laryngoscopic view, it should be modified or released to permit intubation. Succinylcholine remains the neuromuscular agent of choice unless contraindicated. Thiopentone (not propofol) was classically preferred, though propofol is increasingly used.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.