Ketamine versus propofol for rapid sequence induction in trauma patients: a retrospective study

Abstract Background Rapid Sequence Induction (RSI) is used for emergency tracheal intubation to minimise the risk of pulmonary aspiration of stomach contents. Ketamine and propofol are two commonly used induction agents for RSI in trauma patients. Yet, no consensus exists on the optimal induction agent for RSI in the trauma population. The aim of this study was to compare 30-day mortality in trauma patients after emergency intubation prehospitally or within 30 min after arrival in the trauma centre using either ketamine or propofol for RSI. Methods In this investigator-initiated, retrospective study we included adult trauma patients emergently intubated with ketamine or propofol registered in the local trauma registry at Rigshospitalet, a tertiary university hospital that hosts a level-1 trauma centre. The primary outcome was 30-day mortality. Secondary outcomes included hospital and Intensive Care Unit length of stay as well as duration of mechanical ventilation. We analysed outcomes using multivariable logistic regression models adjusting for age, sex, injury severity score, shock (systolic blood pressure < 90 mmHg) and Glasgow Coma Scale score before intubation and present results as odds ratios (ORs) with 95% confidence intervals. Results From January 1st, 2015 through December 31st, 2019 we identified a total of 548 eligible patients. A total of 228 and 320 patients received ketamine and propofol, respectively. The 30-day mortality for patients receiving ketamine and propofol was 20.2% and 22.8% (P = 0.46), respectively. Adjusted OR for 30-day mortality was 0.98 [0.58–1.66], P = 0.93. We found no significant association between type of induction agent and hospital length of stay, Intensive Care Unit length of stay or duration of mechanical ventilation. Conclusions In this study, trauma patients intubated with ketamine did not have a lower 30-day mortality as compared with propofol.

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Difficult airway in the Paediatric Intensive Care Unit

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0010 ◽

2020 ◽

pp. 115-128

Author(s):

Elizabeth O’Donohoe ◽

Thomas Breen ◽

Fiona Reynolds

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Rapid Sequence Induction ◽

Upper Airway ◽

Difficult Tracheal Intubation ◽

Respiratory Physiology ◽

Safe Management ◽

Rapid Sequence ◽

Sequence Induction ◽

Difficult Airways

Children with difficult airways can come to significant harm if not appropriately assessed and managed. Chapter 10 discusses the signs of airway compromise in children and indications for intubation in the Intensive Care Unit (ICU). The role of the paediatric airway in respiratory physiology is examined. Recognizing a difficult paediatric airway is vital in the ICU—common causes of upper airway obstruction are listed and techniques for assessing paediatric airways addressed. The choice of drugs for rapid sequence induction in the Paediatric ICU is explained, and algorithms for the management of the unanticipated difficult tracheal intubation and ‘cannot intubate, cannot ventilate’ illustrated. Finally, the chapter includes the fundamental concepts of team brief, checklists, and crisis resource management in the safe management of difficult airways in children.

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‘Normal’ Vital Signs Belie Occult Hypoperfusion in Geriatric Trauma Patients

The American Surgeon ◽

10.1177/000313481007600113 ◽

2010 ◽

Vol 76 (1) ◽

pp. 65-69 ◽

Cited By ~ 22

Author(s):

Jeremiah T. Martin ◽

Fuad Alkhoury ◽

Judith A. O'Connor ◽

Tassos C. Kyriakides ◽

John A. Bonadies

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Unit Length ◽

Vital Signs ◽

Intensive Care Unit Length ◽

Hospital Length Of Stay ◽

Common Finding ◽

Trauma Patients ◽

Severity Scores

Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with “normal” vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility ( P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.

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Ketamine as a Rapid Sequence Induction Agent in the Trauma Population

Anesthesia & Analgesia ◽

10.1213/ane.0000000000003568 ◽

2019 ◽

Vol 128 (3) ◽

pp. 504-510 ◽

Cited By ~ 3

Author(s):

Josefine S. Baekgaard ◽

Trine G. Eskesen ◽

Martin Sillesen ◽

Lars S. Rasmussen ◽

Jacob Steinmetz

Keyword(s):

Rapid Sequence Induction ◽

Induction Agent ◽

Trauma Population ◽

Rapid Sequence ◽

Sequence Induction

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Manajemen Anestesi pada Wanita Hamil dengan Eklampsia dan Asma Akut Berat yang Menjalani Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v2i2.12 ◽

2020 ◽

Vol 2 (2) ◽

pp. 86-92

Author(s):

Erna Fitriana A ◽

Ratih Kumala Fajar Apsari ◽

Yusmein Uyun

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Caesarean Section ◽

Medical Condition ◽

Rapid Sequence Induction ◽

Airway Disease ◽

Difficult Problem ◽

Rapid Sequence ◽

Sequence Induction ◽

In Pregnancy

Eklampsia dengan asma merupakan kondisi medis yang paling sering terjadi dalam kehamilan. Eklampsia dengan asma akut berat dalam kehamilan merupakan problem yang sulit. Kejadian eklampsia sekitar 2–8% diseluruh dunia dan merupakan penyebab kematian tertinggi kedua setelah perdarahan. Prevalensi terjadinya 0,3%–0,7% pada negara berkembang. Asma merupakan penyakit inflamasi kronis saluran nafas yang melibatkan banyak sel dan elemen seluler yang mengakibatkan terjadinya hiperresponsif jalan nafas yang dapat menimbulkan gejala episodik berulang berupa wheezing, sesak nafas, dada berat dan batuk. Di Indonesia prevalensi berkisar 5-6% dari populasi penduduk, dimana serangan asma biasanya timbul pada usia kehamilan 24–36 minggu. Seorang wanita 28 tahun G1P0A0 datang hamil 35 minggu dengan keluhan sesak, nyeri kepala, kejang tiga kali, kaki bengkak. Dilakukan seksio sesarea dengan anestesi umum. Ventilator mekanik selama seksio sesarea harus disesuaikan untuk menjaga PCO2 30–32 mmHg. Intubasi dilakukan dengan rapid sequence induction dan setelah pipa endotrakheal masuk dijaga tekanan darah supaya tidak meningkat. Setelah operasi selesai dilakukan ekstubasi dalam untuk mencegah gejolak hemodinamik dan mengurangi iritasi saluran nafas. Pasca operasi pasien masuk intensive care unit untuk pemantauan lebih lanjut. Penanganan anestesi yang efektif pada pasien ini akan meningkatkan survival serta memberikan prognosis yang lebih baik Management of Anesthesia in Caesarean Section for Patient with Eclampsia and SevereAcute Asthma Abstract Eclampsia with asthma is the most common medical condition in pregnancy. Eclampsia with severe acute asthma in pregnancy is a difficult problem. The incidence of eckampsia is around 2–8% worldwide and is the second highest cause of death after bleeding. The prevalence of occurrence is 0.3% –0.7% in developing countries. Asthma is a chronic inflammatory airway disease that involves many cells and cellular elements that cause airway hyperresponsiveness which can cause recurrent episodic symptoms such as wheezing, shortness of breath, heavy chest and coughing. In Indonesia the prevalence ranges from 5–6% of the population, where asthma attacks usually occur at 24–36 weeks' gestation. A 28-year-old woman G1P0A0 comes 35 weeks pregnant with complaints of tightness, headache, seizures three times, swollen feet. Caesarean section was performed under general anesthesia. Mechanical ventilator during cesarean section must be adjusted to maintain PCO2 30–32 mmHg. Intubation was done by rapid sequence induction and after the endotracheal tube has been entered, the intracranial pressure is maintained so it did not increase. After the operation was complete, extubation was done to prevent hemodynamic fluctuations and reduce airway irritation. Postoperatively the patient was admitted to the intensive care unit for further monitoring. Effective anesthetic treatment in these patients will increase survival and provide a better prognosis

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Does the Choice of Ketamine or Thiopentone as the Induction Agent for Rapid Sequence Induction in Trauma Affect Outcomes? A Retrospective Observational Pilot Study

Journal of Anesthesia and Surgery ◽

10.15436/2377-1364.16.051 ◽

2016 ◽

Vol 3 (6) ◽

pp. 1-4

Author(s):

Ian Ferguson ◽

Keyword(s):

Pilot Study ◽

Rapid Sequence Induction ◽

Induction Agent ◽

Rapid Sequence ◽

Sequence Induction

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Serial Kasus: Manajemen Anestesi pada Wanita Hamil dengan Plasenta Akreta yang Direncanakan Tindakan Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v3i1.40 ◽

2020 ◽

Vol 3 (1) ◽

pp. 26-34

Author(s):

Purwoko Purwoko ◽

Rio Rusman ◽

M. Ridho Aditya

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

General Anesthesia ◽

Postpartum Hemorrhage ◽

Placenta Accreta ◽

Placenta Previa ◽

Rapid Sequence Induction ◽

Rapid Sequence ◽

Sequence Induction

Perdarahan postpartum merupakan salah satu penyebab utama kematian ibu selain penyakit kardiovaskuler. Diantara penyebab perdarahan post partum adalah plasenta akreta dimana insidennya semakin meningkat dari tahun ke tahun seiring dengan peningkatan jumlah persalinan dengan seksio sesarea. Kami laporkan dua kasus ibu hamil dengan plasenta akreta yang direncanakan tindakan seksio sesarea emergency yang dikelola dengan general anesthesia rapid sequence induction. Kasus pertama, perempuan berusia 31 tahun G3P1A1 usia kehamilan 36–37 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 7000 cc, dan diberikan transfusi 8 unit PRC, 4 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan komplikasi yang terjadi produk drain abdomen sekitar 1900 cc bercampur darah. tidak ada komplikasi mayor lainnya, pasien pindah ruang rawat inap pada hari keempat pascaoperasi. Kasus kedua, perempuan berusia 40 tahun G3P2A0 usia kehamilan 37–38 minggu dalam persalinan, perdarahan antepartum ec plasenta previa totalis, plasenta akreta dengan hemodinamik stabil. Intraoperatif, perdarahan sekitar 9000 cc, dan dilakukan transfusi 8 unit PRC, 8 unit WB, 4 unit FFP, dan 4 unit Tc. Pascaoperasi pasien dirawat di ICU, dan. tidak ada komplikasi signifikan terjadi. Hari kedua pascaoperasi pasien pindah ke ruang rawat inap. Case Series: Anesthesia Management in Pregnant Woman with Placenta Accreta Planned for Caesarean Section Abstract Postpartum hemorrhage is one of the leading causes of maternal morbidity besides cardiovascular disease. Among the causes of postpartum hemorrhage is placenta accreta, where the incidence increases from year to year along with the increase in the number of cesarean delivery. We report two cases of pregnant women with placenta accreta planned for emergency cesarean section managed with general anesthesia rapid sequence induction. The first case, 31-year-old woman G3P1A1 36–37 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 7000 cc, and given transfusion of 8 units of PRC, 4 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and complications that occurred around 1900 cc of abdominal drain product mixed with blood. After that, there were no other major complications, then the patient moved the ward on the fourth day. The second case, a 40-year-old woman G3P2A0 37–38 weeks of gestation in labor, antepartum hemorrhage ec placenta previa totalis, placenta accreta with hemodynamically stable. During procedure, blood loss about 9000 cc, and given transfusion of 8 units of PRC, 8 units of WB, 4 units of FFP, and 4 units of Tc. In the end of procedure, the patient was transferred to intensive care unit, and no significant complications happen. The second day after surgery the patient moved to the ward.

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Comparison of rapid sequence induction intubation conditions with Suxamethonium verses Rocuronium.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3667 ◽

2020 ◽

Vol 27 (04) ◽

pp. 759-764

Author(s):

Aisha Ahmad ◽

Samina Aslam ◽

Amna Tariq ◽

Robina Firdous ◽

Humaira Ahmad ◽

...

Keyword(s):

Cricoid Pressure ◽

Controlled Trial ◽

Rapid Sequence Induction ◽

Induction Agent ◽

Rapid Sequence ◽

Sequence Induction ◽

Group A ◽

Random Number Table ◽

Group B ◽

Agent Group

Objectives: To compare endotracheal intubating conditions in rapid sequence induction using Suxamethonium and Rocuronium. Study Design: Randomized Controlled Trial. Setting: Allied Hospital Faisalabad. Period: From 02-07-2015 to 01-07-2016. Material & Methods: After taking approval from hospital ethical committee, cases of emergency surgery fulfilling the inclusion criteria were enrolled and informed consent was taken after explaining all the procedure to the patient. All the patients were randomly divided into 2 groups by using computer generated random number table. Both groups were induced with thiopentone sodium 5mg/kg, analgesia was given with nalbuphine 0.1mg/kg. Group A was given Suxamethonium in a dose of 1 mg/kg body weight after induction agent. Group B was given 0.6 mg/kg Rocuronium after induction. Intubation was performed after 60 sec in both groups with cricoid pressure. Anesthesia was maintained with O2/N2O in a ratio of 50:50 and isoflurane (0.6-1.0%) in both groups. Anesthesia was stopped at the end of surgery in all the patients. Results: Mean age of the patients was 40.49+11.47 and 43.43+12.88 years, 51.43% and 45.71% were male while 48.57% and 54.29% were females, Comparison of intubation conditions was recorded as 97.14% excellent and 2.86% good in patients received suxamethonium and 82.86% and 17.14% in Rocuronium Group had good conditions. Conclusion: It was found that Suxamethonium is significantly better when compared to Rocuronium for endotracheal intubation conditions in rapid sequence induction.

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