Related Experiment Video
Updated: Jun 19, 2025
05:39
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
1.5K
Postintubation hypotension following rapid sequence intubation with full- vs reduced-dose induction agent
Alicia E Mattson1, Caitlin S Brown1, Benjamin J Sandefur2
1Department of Pharmacy Services, Mayo Clinic Rochester, Rochester, MN, USA.
Summary
Full-dose ketamine for rapid sequence intubation (RSI) in the ED was linked to higher postintubation hypotension (PIH) rates, especially in patients with poorer baseline hemodynamics. Results do not support using reduced-dose induction agents broadly.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Rapid sequence intubation (RSI) is a critical emergency department (ED) procedure.
- Postintubation hypotension (PIH) is a frequent complication of RSI.
- The impact of induction agent selection and dosage on PIH risk requires clarification.
Purpose of the Study:
- To determine the incidence of PIH in ED patients undergoing RSI.
- To compare PIH rates between full-dose and reduced-dose induction agents (etomidate and ketamine).
Main Methods:
- Retrospective, health system-wide cohort study.
- Included adult patients (≥18 years) receiving etomidate or ketamine for RSI from July 2018 to December 2020.
- Defined reduced dose as ketamine ≤1.25 mg/kg or etomidate ≤0.2 mg/kg.
Main Results:
- 909 patients analyzed; 84% received etomidate, 16% ketamine.
- Ketamine group had higher mean pre-intubation shock index (P ≤ 0.001).
- Full-dose ketamine associated with highest PIH rate (36.5%), significantly higher than reduced-dose ketamine (16.7%) and full-dose etomidate (22.8%).
Conclusions:
- Full-dose ketamine linked to increased PIH, but baseline hemodynamics confounded interpretation.
- Study findings do not support the widespread use of reduced-dose induction agents for RSI.
- Further research needed to optimize induction agent selection for minimizing PIH risk.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
114
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
114
01:15Endotracheal Intubation I: Procedure
1.0K
Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
1.0K
01:17Endotracheal Intubation II: Nursing Management
550
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
550
01:20Inhalational Anesthetics: Overview
242
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
242
01:24Endotracheal Tube Extubation
549
Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
549
01:22Stages of General Anesthesia
409
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
409