Beware of etomidate and cricoid pressure during rapid sequence induction

Ketamine: Use in Anesthesia

“…Patients in shock who require ongoing resuscitation have maximal sympathetic activity . An induction dose reduction to 0.5–1 mg/kg may be advisable as hypotension has been described in this situation . The only comparable drug in terms of hemodynamic stability is etomidate.…”

“…Ketamine is appropriate for patients with traumatic brain injury (TBI), despite initial concerns about raised intracranial pressure (ICP) due to a possible increase in cerebrospinal fluid production and rise in partial arterial carbon dioxide pressure (paCO 2 ) . As controlled ventilation, which is facilitated by anesthesia, is critical for control of paCO 2 to prevent secondary brain injury, this issue is not clinically relevant.…”

“…Cerebral autoregulation may also be impaired in TBI with the result that cerebral perfusion pressure is critically dependent on mean arterial pressure. Hence, systemic hemodynamic stability becomes particularly vital . In addition, ketamine's action via NMDA receptor antagonism has been suggested to be beneficial in TBI .…”