Ketamine vs. Etomidate for induction.

[DWR]

There have been pre hospital studies on induction agents over the years which I've honestly not followed much. I work for a slightly busy hospital based system (66,000 calls in '17). We are aggressive with our RSI protocol and starting a proactive analysis on the use of Ketamine vs. Etomidate for induction and the overall hemodynamics they have on the patient. WE ARE taking into consideration that Ketamine doesn't work as well if not at all on obese people. The use Etomidate in people with Adrenal insufficiency will not be looked at. I think the great thing about this study is we are utilizing 911 field EMS (my job), ground and flight critical care and the emergency room. Let me guys know your experiences and opinions.

 

[VFlutter]

Where are you getting the evidence that Ketamine does not work in obese people? What do you consider obese?

What exactly are you trying to find out? Most hospital studies show no difference in mortality between the two. Obviously there are situations when one would be preferred over the other. Lots of literature in the anesthesia would about hemodynamic effects of each.

Is the study going to be blinded or randomized? Is it up to provider preference?

 

[Carlos Danger]

WE ARE taking into consideration that Ketamine doesn't work as well if not at all on obese people.

Wut

 

[EpiEMS]

WE ARE taking into consideration that Ketamine doesn't work as well if not at all on obese people

How...?

 

[VFlutter]

Wut

Well my 300mg vial only has enough for an induction dose of a 150kg patient...

 

[Tigger]

What are you studying? What is the goal? One of my services wants to move to a single induction med (silly), is that also your goal?

 

[Carlos Danger]

OP, I'm glad to hear that your service is inclined to study the effects of your interventions. Few bother with that type of thing at all. It says good things about your service.

But I'm curious why you are looking at this particular question when it has already been studied pretty thoroughly? Pretty much everything you could ever want to know about etomidate and ketamine as induction agents is already out there. Some of that research was done in the out-of-hospital setting, too.

Your comment about ketamine not working in the obese is bizarre…….

 

[E tank]

Old and sick, etomidate. Young and sick, ketamine.

 

[aquabear]

Well my 300mg vial only has enough for an induction dose of a 150kg patient...

Use more than 1 vial.

 

[VFlutter]

Use more than 1 vial.

I know, I was being facetious.

We usually carry three 500mg vials unless they are unavailable then we have the concentrated 300mg vials.