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Thu Aug 2 23:05:11 BST 2007

Disadvantages of Ketamine:

1. tachycardia - many trauma pts. are tachycardic enough already
2. negative inotropic effect (that gets uncovered if catecholamines are depleted and there is an insufficient sympathetic response to the stimulation by Ketamine).
3. seizures (like Etomidate) and increase brain tissue O2 consumption (unlike Etomidate)- problem e.g. in head traumas etc.
4. increased secretions everywhere

If used as analgesic unclear when transition to general anesthesia with aspiration risks ..

If you don't use Midazolam the seizures are more likely, too...

I agree though that it is good in all these other situations, just it cannot be used in a number of situations where Etomidate can..
Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.Lynwood, CA

> From: trauma at emergencyunit.com> To: trauma-list at trauma.org> Date: Thu, 2 Aug 2007 22:19:57 +0100> Subject: RE: Etomidate and RSI> > Kind of Markus to post that editorial; very helpful. My drug of choice in> this circumstance is, and has been for some years, ketamine. I teach it> should NOT be co-administered with a benzodiazepine out of hospital as this> can destroy some of the advantages of ketamine in terms of preservation of> airway reflexes and respiration. It can be used in sub-anaesthetic doses> (around 0.5mg/kg) as a fantastic analgesic during extrication and you can> simply titrate it to response to give deeper and deeper sedation until you> get to around 3mg/kg when the patient is anaesthetised. Even better, given> at 10mg/kg *IM* it will give a smooth induction of anaesthesia. The only> time to use a benzo is if the patient on waking is showing signs of> emergence phenomena. If it is used in the field keep the patient on bolus> ketamine in transit and wake if required in the ED.> > Blueflightmedic.> > -----Original Message-----> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]> On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>> Sent: 02 August 2007 19:09> To: Trauma &amp; Critical Care mailing list> Subject: RE: Etomidate and RSI> > > John> > Thanks - small study, but interesting result. They don't comment on> mortality difference though!! The also don't specify injury type and mix -> ISS is notoriously unreliable to compare groups given the huge variables> that determine the score.> > At least it is food for thought. Attached find an article I put together> reviewing the available literature on the subject, which is yet to be> published (Journal of Trauma did not want it - they rejected it as it only> focussed on Etomidate, rather than all RSI drugs!). Still begs the question> as to what good alternatives are available?> > Not sure if I should even try to submit it anymore given the latest study. > > Thanks too to all who responded to my original query> Regards> Tim> Dr T C Hardcastle > M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) > Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) > ATLS instructor and DSTC Cape Town Course Director > Intern program Coordinator: Surgery > M.Med (Emergency Medicine) Executive Committee member > Clinical Head (Director): Diana Princess of Wales Trauma Unit > Division of Surgery (General) Room 4064 > Department of Surgical Sciences > Tygerberg Hospital / University of Stellenbosch > PO Box 19063 > Tygerberg 7505 > Western Cape > South Africa > e-mail: tch at sun.ac.za > Cell: +27824681615 > Office: +27219389281 or 4911 pager 0302 > > -----Original Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Green, John> Sent: Thursday, August 02, 2007 6:47 PM> To: trauma-list at trauma.org> Subject: Etomidate and RSI> > > There is a nice pilot study to be presenteed at the upcoming AAST in> September that examines this specifically. The abstract is available on the> AAST website. http://www.aast.org> > > John M. Green, M.D.> Section of Acute and Critical Care Surgery> Washington University in St. Louis> > _____ > > From: trauma-list-bounces at trauma.org on behalf of> trauma-list-request at trauma.org> Sent: Thu 8/2/2007 10:59 AM> To: trauma-list at trauma.org> Subject: trauma-list Digest, Vol 50, Issue 3> > > > Send trauma-list mailing list submissions to> trauma-list at trauma.org> > To subscribe or unsubscribe via the World Wide Web, visit> http://list.mistral.net/mailman/listinfo/trauma-list> or, via email, send a message with subject or body 'help' to> trauma-list-request at trauma.org> > You can reach the person managing the list at> trauma-list-owner at trauma.org> > When replying, please edit your Subject line so it is more specific than> "Re: Contents of trauma-list digest..."> > > The materials in this email are private and may contain Protected Health> Information. If you are not the intended recipient be advised that any> unauthorized use, disclosure, copying, distribution or the taking of any> action in reliance on the contents of this information is strictly> prohibited. If you have received this email in error, please immediately> notify the sender via return email. > > > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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Ketamine vs. Etomidate in trauma pts.