What is the difference between preoxygenation and Rapid Sequence Induction in anesthesia?

Question

When I had thumb surgery and the regional block didn't take (and was not tested) the surgeon instructed the nurse anesthetist to put my under after he cut into me and I could feel it. I remember the CRNA saying something like "Sodium penth coming down" then feeling tremendous pain in my arm where the IV was. Seriously it felt like my arm was going to explode. I actually tried to get off the table but within seconds I guess I was out. I didn't have a mask on at the time - just the tube in my nose. Is that Rapid Sequence Anesthesia or Preoxygenation? The anesthesia record says it was preoxygenation. Of course the record fails to note I had a regional block either.

Answer 1

Sounds like a crappy chart.

Pre-oxygenation should be just that: administering oxygen, typically by mask, as a preliminary to RSI, which normally includes a cocktail of drugs and some form of airway control once you're "under."

Answer 2

Pre-oxygenation is actually denitrogenation, but nobody ever calls it that.  It's delivering 100% oxygen by mask for either 2 minutes or 4 big breaths, to replace the residual volume of air in the lungs with oxygen (that's the air that's left in the lungs after you exhale).  We do that so when we take away your ability to breathe, we have longer to get the tube in before you start to desaturate (lose oxygen in the blood).  

So what you remember having was not pre-oxygenation.

Rapid sequence induction is giving the drugs quickly so that you go to sleep and get paralyzed at the same time, and we can get the tube in more quickly, minimizing the time that the airway is unprotected from potentially regurgitated stomach contents.

Who uses pentothal anymore?  Seriously, where did you have this done?  I keep pentothal around in case someone has a seizure, but as an induction agent, there isn't much of a place for it anymore, IMHO.  Propofol for healthy people, and etomidate for those with fragile hearts.  (Few other exceptions, not pertinent here)

It sounds more like you had propofol, because that burns a lot on injection if there's no lidocaine mixed with it.

Sorry you had such a miserable experience.

Answer 3

In the ICU we routinely do RSI using Fentanyl, Versed, and a minute later Vecuronium. We preoxygenate using BVM with 100% O2 until the cocktail takes full effect then we do ETI.