Ketamine represents a rational choice for rapid sequence induction in haemodynamically compromised patients, as adverse effects on intracranial pressure are attenuated by controlled ventilation.
Does ketamine provide optimal haemodynamic stability for rapid sequence induction of anaesthesia in haemodynamically compromised emergency patients?
This review supports the use of ketamine as an induction agent in haemodynamically compromised patients, arguing that its traditional contraindication in brain injury is mitigated by controlled ventilation.
In rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra-indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients.
Morris et al. (Tue,) conducted a review in Haemodynamically compromised emergency patients. Ketamine vs. Etomidate was evaluated. Ketamine represents a rational choice for rapid sequence induction in haemodynamically compromised patients, as adverse effects on intracranial pressure are attenuated by controlled ventilation.