All Prevention of Future Deaths reports received by the RCoA/Association of Anaesthetists are reviewed by SALG and a joint response produced. The RCoA and the Association were requested to respond to a report from a coroner following the sad death of a patient, Mrs Pamela Marking. The report raised concerns relating to the practice of rapid sequence induction (RSI). Full details of the report are available on the coroner’s website.

SALG’s full response can be read here

SALG would like to highlight that the most important step to reduce the risks associated with RSI, as recommended by NAP4,¹ is to undertake an individualised risk assessment and act on it. The NAP4 report states “All patients should have their risk of aspiration assessed and recorded before anaesthesia. The airway management strategy should be consistent with the identified risk of aspiration.” Furthermore, NAP7² recommends “Anaesthetists should treat cases of acute abdomen as high risk for aspiration, assess the extent of that risk and plan airway management accordingly. Each airway manager should decide which elements of RSI they wish to use and be prepared to justify their use or omission.” We reinforce our support for these statements. As part of this, we will publish a best practice statement on RSI.

1. Major Complications of Airway Management in the United Kingdom. Report and findings of the 4^th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP 4). Royal College of Anaesthetists, March, 2011.
2. At the heart of the matter: Report and findings of the 7^th National Audit Project of the Royal College of Anaesthetists examining perioperative cardiac arrest (NAP 7). Royal College of Anaesthetists, November, 2023.