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Original Research

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Changes in hemodynamic parameters with the use of etomidate versus ketamine induction in the emergency department

  • Abdullah Bakhsh1
  • Maryam Alnashri2
  • Fatimah Alawami2
  • Rafal Aseel2
  • Maha Almaghthawi2
  • Ghaida Alrahaili2
  • Anas Bifari2
  • Hassan Algethami2

1Department of Emergency Medicine, the King Abdulaziz University, 80215 Jeddah, Saudi Arabia

2Faculty of Medicine, the King Abdulaziz University, 80215 Jeddah, Saudi Arabia

DOI: 10.22514/sv.2021.005 Vol.17,Issue 2,March 2021 pp.85-92

Published: 08 March 2021

*Corresponding Author(s): Abdullah Bakhsh E-mail:


Objectives: Etomidate is the sedative agent of choice during rapid sequence intubation (RSI) owing to its hemodynamic stability, rapid onset of action, and short duration of action. Nevertheless, ketamine is rapidly gaining popularity as an alternative agent, primarily because of its catecholamine-mediated effects. This feature has prompted clinicians to use ketamine for hemodynamically unstable patients. The aim of this study was to compare the percent change in hemodynamic parameters resulting from the use of etomidate versus ketamine during RSI in the emergency department.

Methods: This cross-sectional prospective observational study conducted at an academic emergency department included patients recruited from March 2018 through May 2019 on a convenience basis when the principal investigator was scheduled to work in the emergency department.

Results: Our study showed a percent reduction in all hemodynamic parameters with the use of ketamine: -13.14% in systolic blood pressure, -10.40% in diastolic blood pressure, -10.15% in mean arterial pressure, and -1.12% in heart rate. Moreover, the rate of ≥ 20% reduction in hemodynamic parameters with ketamine was 27.27% in systolic blood pressure, 18.18% in diastolic blood pressure, 18.18% in mean arterial pressure, and 27.27% in heart rate.

Conclusions: Although ketamine has a sympathomimetic effect, it may cause hemodynamic instability in select patients. Therefore, caution is advised when using ketamine routinely during RSI, especially in critically ill patients in the emergency department.


Rapid sequence induction and intubation; Ketamine; Etomidate; Hemodynamic response; Acute reduction in hemodynamic parameters; Catecholamine depletion

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Abdullah Bakhsh,Maryam Alnashri,Fatimah Alawami,Rafal Aseel,Maha Almaghthawi,Ghaida Alrahaili,Anas Bifari,Hassan Algethami. Changes in hemodynamic parameters with the use of etomidate versus ketamine induction in the emergency department. Signa Vitae. 2021. 17(2);85-92.


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