A Dose of Ketamine Can Facilitate Preoxygenation Before Emergency Intubation

Patients with altered mental status may not be able to undergo preoxygenation, which is required for optimal rapid sequence intubation. In a prospective observational study of 62 such patients, investigators evaluated use of ketamine to induce a dissociative state without respiratory suppression prior to paralysis, in a process the authors named “delayed sequence intubation.”

Patients received 1 mg/kg of ketamine, with additional doses of 0.5 mg/kg as needed to induce a dissociative state. Preoxygenation was then achieved by non-rebreather mask or by noninvasive positive pressure ventilation. Mean oxygen saturation increased from 90% before ketamine administration to 99% after. No complications were observed.