Ketamine-based versus fentanyl-based regimen for rapid-sequence endotracheal intubation in patients with septic shock: A randomised controlled trial
Article Category: Original Paper
Published Online: Dec 29, 2022
Page range: 98 - 104
DOI: https://doi.org/10.2478/rjaic-2021-0017
Keywords
© 2021 Ali et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Objective
The aim of this work is to compared ketamine-based versus fentanyl-based regimens for endotracheal intubation in patients with septic shock undergoing emergency surgery.
Design
This was a randomised double-blinded controlled trial.
Participants
Patients with septic shock on norepinephrine infusion scheduled for emergency surgery.
Setting and Interventions
At induction of anaesthesia, patients were allocated into ketamine group (n=23) in which the participants received ketamine 1 mg/kg, and fentanyl group (n=19) in which the participants received fentanyl 2.5 mcg/ kg. Both groups received midazolam (0.05 mg/kg) and succinyl choline (1 mg/kg).
Measurement
The primary outcome was mean arterial blood pressure. The secondary outcomes included: heart rate, cardiac output, and incidence of postintubation hypotension defined as mean arterial pressure ≤80% of baseline value.
Results
Forty-two patients were available for final analysis. The mean blood pressure was higher in the ketamine group than in the fentanyl group at 1, 2 and 5 minutes after the induction of anaesthesia. Furthermore, the incidence of postinduction hypotension was lower in the ketamine group than in the fentanyl group (11 [47.8%] versus 16 [84.2%], P-value= 0.014). Other hypodynamic parameters, namely the heart rate and cardiac output, were comparable between both groups; and were generally maintained in relation to the baseline reading in each group.
Conclusion
The ketamine-based regimen provided better hemodynamic profile compared to fentanyl-based regimen for rapid-sequence intubation in patients with septic shock undergoing emergency surgery.