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Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine.
West J Emerg Med 2019; 20(3):466-471WJ

Abstract

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.

Authors+Show Affiliations

Rocky Vista University College of Osteopathic Medicine, Parker, Colorado.University of Minnesota Medical School, Minneapolis, Minnesota. North Memorial Health Ambulance and AirCare, Brooklyn Center, Minnesota.Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31123547

Citation

Merelman, Andrew H., et al. "Alternatives to Rapid Sequence Intubation: Contemporary Airway Management With Ketamine." The Western Journal of Emergency Medicine, vol. 20, no. 3, 2019, pp. 466-471.
Merelman AH, Perlmutter MC, Strayer RJ. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. West J Emerg Med. 2019;20(3):466-471.
Merelman, A. H., Perlmutter, M. C., & Strayer, R. J. (2019). Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. The Western Journal of Emergency Medicine, 20(3), pp. 466-471. doi:10.5811/westjem.2019.4.42753.
Merelman AH, Perlmutter MC, Strayer RJ. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management With Ketamine. West J Emerg Med. 2019;20(3):466-471. PubMed PMID: 31123547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. AU - Merelman,Andrew H, AU - Perlmutter,Michael C, AU - Strayer,Reuben J, Y1 - 2019/04/26/ PY - 2019/02/14/received PY - 2019/04/08/revised PY - 2019/04/06/accepted PY - 2019/5/25/entrez PY - 2019/5/28/pubmed PY - 2019/5/28/medline SP - 466 EP - 471 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 20 IS - 3 N2 - 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. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/31123547/Alternatives_to_Rapid_Sequence_Intubation:_Contemporary_Airway_Management_with_Ketamine L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31123547/ DB - PRIME DP - Unbound Medicine ER -