Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?
Article first published online: 7 APR 2009
© 2009 The Authors. Journal compilation © 2009 The Association of Anaesthetists of Great Britain and Ireland
Volume 64, Issue 5, pages 532–539, May 2009
How to Cite
Morris, C., Perris, A., Klein, J. and Mahoney, P. (2009), Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?. Anaesthesia, 64: 532–539. doi: 10.1111/j.1365-2044.2008.05835.x
- Issue published online: 7 APR 2009
- Article first published online: 7 APR 2009
- Accepted: 20 November 2008
In rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra-indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients.