Ketamine-induced Changes in Blood Pressure and Heart Rate in Pre-hospital Intubated Patients

Abstract

A B S T R A C TWhen a patient experiences trauma, pre-hospital rapid sequence intubation (RSI) is often the course of action. While RSI is associated with favorable neurological outcomes among traumatic brain injury patients, it also carries the risk of increased hypotension and bradycardia. Ketamine is a fast-acting anesthetic agent used in RSI, attractive due to its ability to raise heart rate (HR) and blood pressure (BP) and thus potentially lessening the severity of RSIrelated hypotension and bradycardia. However, research in support of its use is inconclusive, with different studies reporting increases or decreases in BP and HR after ketamine administration. To study the effect of ketamine on HR and BP during RSI, we analyzed the data obtained from 1,516 patients who received trauma and nontrauma medical care including RSI from first responders and emergency personnel using two different statistical methods. We determined if there was any association between the vital signs prior to administration of ketamine and outcomes such as bradycardia and/or hypotension post-ketamine administration in patients undergoing RSI. We found that the vital signs prior to administration of ketamine (i.e. BP and HR) predict the development of bradycardia and/or hypotension in patients undergoing RSI and the relationship between baseline vital signs and the development of bradycardia and/or hypotension is moderated by the dose of ketamine. Results obtained from this study may help responders and emergency care personnel to identify the patients that are likely to benefit from ketamine as an anesthetic agent.

A Case of Bradycardia and Hypersensitivity with Intravenous Ketamine Monotherapy

“…The transient isolated bradycardia (without other cardiovascular abnormalities) that was witnessed resolved spontaneously. Sheth et al have postulated that oldage, lower baseline vitals, and non-trauma patients are more likely to predict the occurrence of bradycardia after ketamine injection [6]. We believe that the old age and low baseline heart rate could have resulted into the bradycardia response.…”

Opioid-Free Anesthesia in Bariatric Surgery: Is It the One and Only? A Comprehensive Review of the Current Literature

“…The effect of ketamine is ambiguous, although increasing the tension of the sympathetic nervous system causes an increase in HR, BP, and SV (Stroke Volume) while maintaining SVR. Still, in some patients, it may have a negative inotropic effect, causing hypotension and bradycardia [ 81 ]. Taking into account the effects mentioned above, hypotension when using OFA may be a problem and require the use of sympathomimetics such as ephedrine or catecholamines more frequently and in higher doses than in conventional anesthesia with multimodal analgesia, as well as more aggressive fluid therapy [ 14 ].…”

Combination of articaine and ketamine V/S articaine alone after surgical extraction of impacted third molars

“…Sheth et al . 2018[ 17 ] studied the effect of ketamine on HR and BP during Rapid Sequence Intubation (RSI) and found that higher doses (>200 mg) and moderately high doses (151–200 mg) of ketamine was more associated with hypertension than lower doses. Patients who received ketamine doses >150 mg were 1.3 times more likely to develop hypotension or hypertension after ketamine administration when compared to patients who received doses <150 mg; However, the results of this study are similar to the results of present study.…”