An ambitious recent systematic review of the limited available high quality evidence attempted to establish which factors improved or failed to improve the success and safety of RSI. Alternatively, it may be that emergency anaesthesia has simply evolved with developments in anaesthesia and emergency medicine in terms of technique, training and new drugs and equipment. This may be because little good evidence has been published since the original description to indicate that traditional RSI effectively reduces aspiration or improves patient outcomes. Almost every element of the original technique has been challenged or adapted. However, in recent years this consensus has rapidly declined and the emergency anaesthesia literature has revealed considerable variation and controversy in how the intervention is delivered. This led to a remarkably consistent approach to emergency anaesthesia for many years and this technique is still widely practiced in many countries. The traditional method describes: denitrogenation of the lungs with 100% oxygen for at least 2 min, induction with a pre-determined dose of thiopentone, application of cricoid pressure, administration of a pre-determined dose of suxamethonium, a period of apnoea with no positive pressure ventilation, tracheal intubation with a cuffed tracheal tube, and the release of cricoid pressure when tube placement is successfully confirmed. It followed the work by Sellick on the use of cricoid pressure to prevent reflux of gastric contents during induction. Rapid Sequence Induction (RSI) of anaesthesia was described in 1970 by Stept and Safar. Rapid induction of anaesthesia and tracheal intubation is used in the management of critically unwell patients to address the long-recognised risk of aspiration of gastric contents and unnecessary morbidity and mortality. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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