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Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine
Andrew H Merelman1, Michael C Perlmutter2,3, Reuben J Strayer4
1Rocky Vista University College of Osteopathic Medicine, Parker, Colorado.
The Western Journal of Emergency Medicine
|May 25, 2019
Summary
Ketamine offers safer alternatives to traditional rapid sequence intubation (RSI) for endotracheal intubation (ETI). These methods, including delayed sequence intubation and ketamine-only breathing intubation, enhance patient safety in critical situations.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Endotracheal intubation (ETI) is a critical procedure with inherent risks.
- Traditional rapid sequence intubation (RSI) may pose risks to unstable patients.
- Patient factors like hypoxia or difficult airways complicate standard RSI.
Purpose of the Study:
- To explore ketamine's role in alternative intubation strategies.
- To enhance patient safety during endotracheal intubation.
- To present delayed sequence intubation and ketamine-only breathing intubation as RSI alternatives.
Main Methods:
- Review of ketamine's pharmacological properties.
- Description of delayed sequence intubation (DSI) protocol.
- Description of ketamine-only breathing intubation (KOBI) protocol.
Main Results:
- Ketamine facilitates airway preparation and preoxygenation in agitated patients (DSI).
- Ketamine enables spontaneous breathing during intubation (KOBI), avoiding paralytics.
- Ketamine offers potential hemodynamic benefits and post-intubation sedation.
Conclusions:
- Ketamine provides valuable alternatives to RSI for endotracheal intubation.
- DSI and KOBI can improve airway management safety in high-risk patients.
- Ketamine's unique profile enhances safety in critical airway procedures.
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