October 2020

Abstract 3: Ketamine vs. Etomidate And Peri-Intubation Hypotension: NEAR Study

EMA 2020 October28 Chapters

  1. Introduction5:04
  2. Ultra Summary31:14
  3. Time To Talk A Little Nerdy: An Interview With a Study Author14:51
  4. Farewell1:38
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Sean R. -

It's important to remember that ketamine possesses a direct negative inotropic effect. However, this is typically overshadowed by the sympathetic response caused by release of endogenous catecholamines after ketamine administration. This increased sympathetic activity is what we're used to seeing when performing procedural sedation in the ED.

I think a lot of us have simply decided that since it raises BP and pulse rate in these scenarios, it's likely the best choice for induction at the time of intubation for a hypotensive patient. Unfortunately, it's likely that many of these patients (ie - septic shock) have exhausted their endogenous catecholamines as a result of their body's attempt to compensate for the illness. In the absence of this catecholamine reserve all we see is the negative inotropic effect. This appears to be more common in medical patients than in trauma, suggesting that length of illness prior to intubation may contribute to catecholamine depletion.

I certainly use ketamine a lot more for intubation than I used to, but I'm much more cautious in those I feel are likely to decompensate. As much as I don't love etomidate, it's usually my go to for those in septic shock.

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