Association of fentanyl use in rapid sequence intubation with post-intubation hypotension

Takahashi, Jin; Goto, Tadahiro; Okamoto, Hiroshi; Hagiwara, Yusuke; Watase, Hiroko; Shiga, Takashi; Hasegawa, Kohei

doi:10.1016/j.ajem.2018.03.026

Cited by 19 publications

(15 citation statements)

References 29 publications

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“…The outcome measure of interest was post-intubation hypotension, defined as SBP of ≤90 mmHg during the 30-minute period following intubation or ≥20% decrease in SBP between pre-intubation and immediately after intubation 3,19,24,29,31 .…”

Section: Methodsmentioning

confidence: 99%

Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department

Ishimaru¹,

Goto

Hagiwara

et al. 2019

Sci Rep

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To determine whether ketamine use for tracheal intubation, compared to other sedative use, is associated with a lower risk of post-intubation hypotension in hemodynamically-unstable patients in the emergency department (ED), we analyzed the data of a prospective, multicenter, observational study—the second Japanese Emergency Airway Network (JEAN-2) Study—from February 2012 through November 2017. The current analysis included adult non-cardiac-arrest ED patients with a pre-intubation shock index of ≥0.9. The primary exposure was ketamine use as a sedative for intubation, with midazolam or propofol use as the reference. The primary outcome was post-intubation hypotension. A total of 977 patients was included in the current analysis. Overall, 24% of patients developed post-intubation hypotension. The ketamine group had a lower risk of post-intubation hypotension compared to the reference group (15% vs 29%, unadjusted odds ratio [OR] 0.45 [95% CI 0.31–0.66] p < 0.001). This association remained significant in the multivariable analysis (adjusted OR 0.43 [95% CI 0.28–0.64] p < 0.001). Likewise, in the propensity-score matching analysis, the patients with ketamine use also had a significantly lower risk of post-intubation hypotension (OR 0.47 [95% CI, 0.31–0.71] P < 0.001). Our observations support ketamine use as a safe sedative agent for intubation in hemodynamically-unstable patients in the ED.

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Section: Methodsmentioning

confidence: 99%

Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department

Ishimaru¹,

Goto

Hagiwara

et al. 2019

Sci Rep

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“…Lidocaine is used for reducing the risk of bronchospasm when β 2 agonist therapy has not been given . Fentanyl can mitigate the cardiovascular effects of sympathetic nervous system stimulation but has a potential risk of hypotension . Of note, atropine is not used for premedication in adults but it should be available as a rescue medication if bradycardia occurs.…”

Section: Medicationsmentioning

confidence: 99%

“…Over the past decade, the NEAR group has also made a substantial impact on the international emergency medicine research community, including the KEAMR and JEAN groups . For example, the JEAN study is a multicenter prospective effort that is run by the Japanese Emergency Medicine Network (JEMNet) (http://jemnet.asia/wp/).…”

Section: Summary and Future Directionsmentioning

confidence: 99%

Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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“…The included study was a secondary analysis of a prospectively collected airway registry from 14 emergency departments in Japan . The registry included 7570 of 7804 patients undergoing intubation in participating EDs between February 2012 and November 2016 (97% capture rate).…”

Section: Resultsmentioning

confidence: 99%

Does the addition of fentanyl to ketamine improve haemodynamics, intubating conditions or mortality in emergency department intubation: A systematic review

Ferguson

Bliss

Åneman

2019

Acta Anaesthesiol Scand

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Background Ketamine is an induction agent frequently used for general anaesthesia in emergency medicine. Generally regarded as haemodynamically stable, it can cause hypertension and tachycardia and may cause or worsen shock. The effects of ketamine may be improved by the addition of fentanyl to the induction regime. We conducted a systematic review to identify evidence with regard to the effect of adding fentanyl to an induction regime of ketamine and a paralysing agent on post‐induction haemodynamics, intubating conditions and mortality. Methods We conducted a search of the Cochrane library, EMBASE, MEDLINE, PROQUEST, OpenGrey and clinical trial registries. Prominent authors were contacted in order to identify additional literature pertinent to the research question. Studies were included if they pertained to intubation of adult patients in the prehospital or emergency department environments and included an induction regime of ketamine and a paralysing agent, with at least one outcome measure of haemodynamics, intubating conditions or mortality. Search results were reviewed by two investigators independently, adjudicated by a third investigator where disagreement occurred. Results One observational study was identified that partially answered the research question. Discussion Only one observational study was identified that partially answered the research question. This paper demonstrated that the use of fentanyl as a pretreatment increases the incidence of post‐induction hypotension, a phenomenon that was seen with propofol, midazolam and ketamine. The difference in hypotension between these agents was not statistically significant. The impact of this on patient‐orientated outcomes is unclear.

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Association of fentanyl use in rapid sequence intubation with post-intubation hypotension

Cited by 19 publications

References 29 publications

Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department

Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department

Advancing emergency airway management practice and research

Does the addition of fentanyl to ketamine improve haemodynamics, intubating conditions or mortality in emergency department intubation: A systematic review

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