Journal Article

Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine

Merelman, Andrew, Perlmutter, Michael, Strayer, Reuben

2019

Overview

Endotracheal intubation (ETI) is a high-risk procedure commonly performed in emergency medicine, critical care, and the prehospital setting. Traditional rapid sequence intubation (RSI), the simultaneous administration of an induction agent and muscle relaxant, is more likely to harm patients who do not allow appropriate preparation and preoxygenation, have concerning airway anatomy, or severe hypoxia, acidemia, or hypotension. Ketamine, a dissociative anesthetic, can be used to facilitate two alternatives to RSI to augment airway safety in these scenarios: delayed sequence intubation - the use of ketamine to allow airway preparation and preoxygenation in the agitated patient; and ketamine-only breathing intubation, in which ketamine is used without a paralytic to facilitate ETI as the patient continues to breathe spontaneously. Ketamine may also provide hemodynamic benefits during standard RSI and is a valuable agent for post-intubation analgesia and sedation. When RSI is not an optimal airway management strategy, ketamine's unique pharmacology can be harnessed to facilitate alternative approaches that may increase patient safety.

• Publisher: University of California Digital Library - eScholarship,Department of Emergency Medicine, University of California, Irvine School of Medicine,eScholarship Publishing, University of California
• Subject: Airway management / Anesthetics, Dissociative - pharmacology / Critical Care / Emergency Medical Services - methods / Humans / Intubation / Intubation, Intratracheal - adverse effects / Intubation, Intratracheal - methods / Ketamine / Ketamine - pharmacology / Patient safety