rapid sequence intubation guidelines 2013

Ketamine, a dissociative anesthetic classically used to facilitate painful procedures in non-intubated patients, has unique properties that offer patient-safety advantages over traditional RSI induction agents. Traditional RSI, however, is burdened by the crucial risks of hypoxia and acidosis should ETI and assisted ventilation fail, as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation. 1, 2 Rapid sequence intubation (RSI), which uses the simultaneous administration of an induction agent and paralytic, is the most common method of facilitating ETI. Despite its prevalence, ETI is associated with considerable patient morbidity and mortality, and is considered the riskiest commonly-performed procedure in acute care. 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.Īirway management and endotracheal intubation (ETI) are life-saving interventions frequently performed in emergency medicine (EM), critical care, and prehospital medicine. Ketamine may also provide hemodynamic benefits during standard RSI and is a valuable agent for post-intubation analgesia and sedation. 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. 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. Endotracheal intubation (ETI) is a high-risk procedure commonly performed in emergency medicine, critical care, and the prehospital setting.

Rapid sequence intubation guidelines 2013