So what’s the perfect Rapid Sequence Induction Drugs?

In this recently published Brief Report in the Journal of Academic Emergency Medicine Patanwala et al. looked retrospectively at first pass intubation success by comparing Ketamine to Etomidate. The final cohort included 2098 patients and even after adjusting for potential confounders there was no difference in success rates between the two drugs. In regards of recent discussions on the safety of Etomidate (e.g. adrenal suppression) this study seems to be another puzzle piece favoring other induction agents than Etomidate.

Looking at recent publications on paralyzing agents and personal experience I feel that Ketamine and Rocuronium is a favorable combination for rapid sequence inductions in the ICU… what do you think?

Patanwala A et al.Academic Emergency. 2014 Feb

Curley J et al. Critical Care. 2011,15:190

Marsch SC et al.Crit Care. 2011 Aug 16;15(4):R199

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