Read by QxMD icon Read

ketamine in rsi

Leressè Pillay, Timothy Hardcastle
INTRODUCTION: Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient . AIM: To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing: premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence...
September 19, 2016: World Journal of Surgery
Karim Nasseri, Sanaz Arvien
OBJECTIVE: Despite the many complications of succinylcholine, it is still widely used as a superior muscle relaxant for rapid sequence induction. One of these complications is postoperative myalgia (POM). The aim of this study was to investigate the prophylactic effect of low-dose ketamine on the incidence and severity of POM. MATERIALS AND METHODS: In this double-blind clinical study, a total of 148 patients scheduled for general anesthesia were randomly divided into two equal groups...
2016: Journal of Pain Research
Başak Ceyda Meço, Ahmet Onat Bermede, Zekeriyya Alanoğlu, Olcay Yaka, Neslihan Alkış
OBJECTIVE: This prospective, randomized, double-blinded study aimed to compare the effects of three different doses of ketamine or lidocaine on intubating conditions and haemodynamics in a rapid-sequence induction model with 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium. METHODS: A total of 128 ASA I-III patients who were scheduled for elective surgery were randomized in the following five groups: Group 1 (n=24), 1 mg kg(-1) lidocaine+3 mg kg(-1) propofol+0...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Matthew Miller, Natalie Kruit, Charlotte Heldreich, Sandra Ware, Karel Habig, Cliff Reid, Brian Burns
STUDY OBJECTIVE: Ketamine is considered a stable induction agent for rapid sequence induction; however, hypotension rates up to 24% are reported. The shock index (shock index=pulse rate/systolic blood pressure [SBP]) may identify patients at risk of adverse hemodynamic change. We investigate whether SBP and pulse rate response to ketamine induction differ when patients are classified as being at risk of shock by their shock index. METHODS: We conducted a prospective observational study of electronically collected vital sign data from patients undergoing rapid sequence induction with ketamine...
August 2016: Annals of Emergency Medicine
Mi-Hyun Kim, Ah-Young Oh, Sung-Hee Han, Jin-Hee Kim, Jung-Won Hwang, Young-Tae Jeon
STUDY OBJECTIVES: We compared magnesium sulphate with control, ketamine, rocuronium prime, and large-dose rocuronium (0.9 mg/kg) with regard to intubation conditions during rapid-sequence induction. DESIGN: This is a prospective, randomized, double-blinded study. SETTING: The setting is at an operating room in a university-affiliated hospital. PATIENTS: One hundred ten patients scheduled for general anesthesia were randomly allocated to the following 5 groups in equal numbers...
November 2015: Journal of Clinical Anesthesia
Richard M Lyon, Zane B Perkins, Debamoy Chatterjee, David J Lockey, Malcolm Q Russell
INTRODUCTION: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium...
2015: Critical Care: the Official Journal of the Critical Care Forum
E Andrew, A de Wit, B Meadley, S Cox, S Bernard, K Smith
OBJECTIVE: The optimal staffing of helicopter emergency medical services (HEMS) is uncertain. An intensive care paramedic-staffed HEMS has operated in the state of Victoria, Australia for over 28 years, with paramedics capable of performing advanced procedures, including rapid sequence intubation, decompression of tension pneumothorax, and cricothyroidotomy. Administration of a wide range of vasoactive, anesthetic, and analgesic medications is also permitted. We sought to explore the characteristics of patients transported by HEMS in Victoria, and describe paramedic utilization of their skill set in the prehospital environment...
July 2015: Prehospital Emergency Care
Carl McQueen, Nick Crombie, Stef Cormack, Arun George, Steve Wheaton
INTRODUCTION: The utilisation of Helicopter Emergency Medical Services (HEMS) in response to equestrian accidents has been an integral part of operations for many years throughout the UK. The recent establishment of major trauma networks in the UK has placed great emphasis on the appropriate tasking of HEMS units to cases where added benefit can be provided and the incidence of time critical injury in cases of equestrian accidents has been shown to be low. This study assesses the impact made on the utilisation of the different HEMS resources for cases of equestrian accidents within the West Midlands following the launch of the regional trauma network...
May 2015: Injury
Asad E Patanwala, Courtney B McKinney, Brian L Erstad, John C Sakles
OBJECTIVES: The objective of this study was to compare first-pass intubation success between patients who received etomidate versus ketamine for rapid sequence intubation (RSI) in the emergency department (ED). METHODS: This was a retrospective analysis of prospectively collected data recorded in a quality improvement database between July 1, 2007, and December 31, 2012. The study was conducted in an academic ED in the United States. All patients who received etomidate or ketamine as part of RSI were included...
January 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Joanna L Stollings, Daniel A Diedrich, Lance J Oyen, Daniel R Brown
OBJECTIVE: To summarize published data regarding the steps of rapid-sequence intubation (RSI); review premedications, induction agents, neuromuscular blockers (NMB), and studies supporting use or avoidance; and discuss the benefits and deficits of combinations of induction agents and NMBs used when drug shortages occur. DATA SOURCE: A search of Medline databases (1966-October 2013) was conducted. STUDY SELECTION AND DATA EXTRACTION: Databases were searched using the terms rapid-sequence intubation, fentanyl, midazolam, atropine, lidocaine, phenylephrine, ketamine, propofol, etomidate thiopental, succinylcholine, vecuronium, atracurium, and rocuronium...
January 2014: Annals of Pharmacotherapy
Bryan G Maxwell, Katherine B Harrington, Nate E Kelly
A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine...
January 2013: Annals of Cardiac Anaesthesia
Shana L Ballow, Krista L Kaups, Staci Anderson, Michelle Chang
BACKGROUND: In the emergency department (ED) of a teaching hospital, rapid sequence intubation (RSI) is performed by physicians with a wide range of experience. A variety of medications have been used for RSI, with potential for inadequate or excessive dosing as well as complications including hypotension and the need for redosing. We hypothesized that the use of a standardized RSI medication protocol has facilitated endotracheal intubation requiring less medication redosing and less medication-related hypotension...
December 2012: Journal of Trauma and Acute Care Surgery
Daniel Scherzer, Mark Leder, Joseph D Tobias
When caring for critically ill children, airway management remains a primary determinant of the eventual outcome. Airway control with endotracheal intubation is frequently necessary. Rapid sequence intubation (RSI) is generally used in emergency airway management to protect the airway from passive regurgitation of gastric contents. Along with a rapid acting neuromuscular blocking agent, sedation is an essential element of RSI. A significant safety concern regarding sedatives is the risk of hypotension and cardiovascular collapse, especially in critically ill patients or those with pre-existing comorbid conditions...
April 2012: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Beatrice de la Grandville, Diego Arroyo, Bernhard Walder
Etomidate is an imidazole-derived hypnotic agent preferentially used for rapid sequence induction of anaesthesia because of its favourable haemodynamic profile. However, 11β-hydroxylase inhibition causes adrenal insufficiency with potentially fatal consequences in specific populations. We review the arguments against the liberal administration of etomidate in critically ill, and especially septic, patients. This review considered only high-quality and prospective studies with a low risk of bias. Three major effects have been observed with the clinical use of a single dose of etomidate...
November 2012: European Journal of Anaesthesiology
Elisabeth Dewhirst, W Joshua Frazier, Marc Leder, Douglas D Fraser, Joseph D Tobias
Given their relative hemodynamic stability, ketamine and etomidate are commonly chosen anesthetic agents for sedation during the endotracheal intubation of critically ill patients. As the use of etomidate has come into question particularly in patients with sepsis, due to its effect of adrenal suppression, there has been a shift in practice with more reliance on ketamine. However, as ketamine relies on a secondary sympathomimetic effect for its cardiovascular stability, cardiovascular and hemodynamic compromise may occur in patients who are catecholamine depleted...
November 2013: Journal of Intensive Care Medicine
G Matthes, M Bernhard, K G Kanz, C Waydhas, M Fischbacher, M Fischer, B W Böttiger
Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate  < 6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)  < 90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)  < 9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)  < 90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate  > 29/min)...
March 2012: Der Unfallchirurg
Kendra Sih, Samuel G Campbell, John M Tallon, Kirk Magee, Peter J Zed
OBJECTIVE: To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury in need of definitive airway management. DATA SOURCES: PubMed (1949-July 2011), EMBASE (1980-July 2011), Google Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were searched independently...
December 2011: Annals of Pharmacotherapy
M Bernhard, G Matthes, K G Kanz, C Waydhas, M Fischbacher, M Fischer, B W Böttiger
Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min)...
November 2011: Der Anaesthesist
Jeremy P Hampton
PURPOSE: The pharmacology, pharmacokinetics, safety, and dosing of medications used during the pretreatment and paralysis with induction steps of rapid-sequence intubation (RSI) and the role of the pharmacist in RSI are reviewed. SUMMARY: RSI is a process involving the administration of a sedative induction agent and a paralytic agent to facilitate endotracheal intubation. This is a procedure in which the emergency department (ED) pharmacist can play an integral role, especially in the steps of pretreatment, paralysis with induction, and postintubation management...
July 15, 2011: American Journal of Health-system Pharmacy: AJHP
Alessandro Di Filippo, Chiara Gonnelli
Rapid sequence intubation is an essential bullet in the maintenance of patency of the airway during intubation in emergency. It is a valid method in all those situations where you can not determine whether the patient is fasting or not. But RSI is not applicable in all critically ill patients. The presence of severe acidosis, depletion of intravascular volume, heart failure and severe pulmonary disease may complicate the pre-induction period as the induction, leading to the onset of vasodilatation and hypotension...
September 2009: Reviews on Recent Clinical Trials
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"