دورية أكاديمية
أعرض في EDS

Does the choice of induction agent in rapid sequence intubation in the emergency department influence the incidence of post-induction hypotension?

التفاصيل البيبلوغرافية
العنوان: Does the choice of induction agent in rapid sequence intubation in the emergency department influence the incidence of post-induction hypotension?
المؤلفون: Tamsett Z; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia., Douglas N; Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia., King C; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia.; School of Medicine, Deakin University, Geelong, Victoria, Australia., Johnston T; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia., Bentley C; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia., Hao B; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia., Prinsloo D; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia., Bourke EM; Department of Emergency Medicine, Grampians Health, Ballarat, Victoria, Australia.; Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
المصدر: Emergency medicine Australasia : EMA [Emerg Med Australas] 2024 Jun; Vol. 36 (3), pp. 340-347. Date of Electronic Publication: 2023 Nov 29.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Blackwell Pub Country of Publication: Australia NLM ID: 101199824 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1742-6723 (Electronic) Linking ISSN: 17426723 NLM ISO Abbreviation: Emerg Med Australas Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Wes Melbourne, Victoria : Blackwell Pub., c2004-
مواضيع طبية MeSH: Emergency Service, Hospital*/statistics & numerical data , Hypotension*/epidemiology , Hypotension*/drug therapy , Hypotension*/etiology , Rapid Sequence Induction and Intubation*/methods , Ketamine*/therapeutic use , Propofol*/adverse effects , Propofol*/therapeutic use , Propofol*/administration & dosage, Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Adult ; Incidence ; Fentanyl/therapeutic use ; Intubation, Intratracheal/methods ; Australia/epidemiology
مستخلص: Objective: To describe the effects of different induction agents on the incidence of post-induction hypotension (PIH) and its associated interventions during rapid sequence intubation (RSI) in the ED.
Methods: A single centre retrospective study of patients intubated between 2018 and 2021 was conducted in a regional Australian ED. The impact of induction agent choice, in addition to demographic and clinical factors on the incidence of PIH were determined using descriptive statistics and a multivariate analysis presented as adjusted odds ratios (aORs) and their 95% confidence intervals (CIs).
Results: Ketamine and propofol, used either individually or in conjunction with fentanyl, were significantly associated with PIH (ketamine aOR 4.5, 95% CI 1.35-14.96; propofol aOR 4.88, 95% CI 1.46-16.29). Age >60 years was associated with a greater requirement for vasopressors (aOR 4.46, 95% CI 2.49-7.97) and a higher risk of mortality after RSI (aOR 4.2, 95% CI 1.87-9.40). Patients with a shock index >1.0 were significantly more likely to require vasopressors (aOR 5.13, 95% CI 2.35-11.2) and have a cardiac arrest within 15 min of RSI (aOR 3.56, 95% CI 1.07-11.8).
Conclusions: Exposure to both propofol and ketamine is significantly associated with PIH after RSI, alongside age and shock index. PIH is likely multifactorial in nature, and this data supports the sympatholytic effect of induction agents as the underlying cause of PIH rather than the choice of agent itself. Further prospective work including a randomised controlled trial between induction agents is justified to further clarify this important clinical question.
(© 2023 Australasian College for Emergency Medicine.)
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فهرسة مساهمة: Keywords: anaesthetic morbidity; induction agents; post‐induction hypotension; rapid sequence intubation
تواريخ الأحداث: Date Created: 20231129 Date Completed: 20240519 Latest Revision: 20240519
رمز التحديث: 20240520
DOI: 10.1111/1742-6723.14355
PMID: 38018391
قاعدة البيانات: MEDLINE
الوصف
تدمد:1742-6723
DOI:10.1111/1742-6723.14355