Thiopental-Rocuronium Versus Ketamine-Rocuronium for Rapid-Sequence Intubation in Parturients Undergoing Cesarean Section

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

“…Hence intravenous anaesthetic agents with the shortest t 1 ⁄ 2 K eo are generally best suited to the non-titrated use in RSI (Table 1). Consistent with this notion, a study using ketamine 1.5 mg.kg )1 vs thiopentone 4 mg.kg )1 in obstetric practice (RSI with rocuronium 0.6 mg.kg )1 ) reported satisfactory conditions for early intubation (45 s) in all cases in ketamine, while thiopentone caused difficulty in 75% of cases [5].…”

“…We conducted a formal literature search of the literature using relevant search terms. This retrieved > 10 000 citations using the single search term 'ketamine', but only two of these were human clinical trials in the context of RSI [5,47]. Thus there appears huge disparity between the ubiquity of RSI performed daily worldwide, and its (under)representation in the literature.…”

“…We have summarised key references on the clinical use of ketamine in Table 2: of the > 10 000 articles retrieved, only the 12 studies quoted make meaningful comment (with supporting evidence) on the use of ketamine in RSI in situations of haemodynamic compromise, and only two of these directly compared ketamine with another agent [5,47]. In emergency surgical patients ketamine increased mean arterial pressure by a mean of 10% and White concluded that it thus '[offers] an advantage over thiopental in situations where hemodynamic stability is crucial' [47].…”

“…In emergency surgical patients ketamine increased mean arterial pressure by a mean of 10% and White concluded that it thus '[offers] an advantage over thiopental in situations where hemodynamic stability is crucial' [47]. In obstetric RSI (with rocuronium as neuromuscular blocker), ketamine enabled earlier (by $45 s) and easier tracheal intubation than thiopentone [5].…”

Ketamine, but not priming, improves intubating conditions during a propofol–rocuronium induction

“…A number of studies have supported the hypothesis that ketamine improves orotracheal intubating conditions compared with thiopental. 9,16,17 In another study, intubating conditions after 60 s following administration of 0.6 mg Á kg -1 rocuronium were compared with intubating conditions following the combinations of ketamine-etomidate, fentanyl-etomidate, or placebo-etomidate during induction. Better intubating conditions were observed in the ketamine-etomidate group, although the onset time was the same.…”