Cite this post as:
Scott Weingart, MD FCCM. EMCrit – George Kovacs on Ketamine-Facilitated Intubation (KFI). EMCrit Blog. Published on May 10, 2019. Accessed on March 20th 2025. Available at [https://emcrit.org/emcrit/ketamine-facilitated-intubation/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: May 10, 2019
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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Have done ketamine-only breathing intubation a handful of times in the past. The major problem encountered was emesis. I think there might also be an increased risk of vocal cord trauma as the cords aren’t relaxed while you’re inserting the tube. Be careful – this technique is *not* a panacea.
interesting – I’ve never seen emesis once and I’ve done dozens. are you giving full dissociative dose? vomiting DURING dissociation? even with ketamine-preserved airway reflexes, dangerous.
definitely no panacea, but neither is paralysis. patients at particular risk to be harmed by paralysis should be considered for a breathing technique. intensivists are less RSI-crazed but downstairs we RSI essentially everyone. And most of the time that’s the right move because RSI is an awesome technique, but there are circumstances when we should be thinking of alternatives.
I have done more intubations than most EM docs will do in a lifetime (many thousands) and have a first pass rate of >99.5%. I have done the ‘nice’ stuff such as emergency C sections,,halo frames,, very unstable C spines, etc I have seen a bit but there’s a lot more things I haven’t done or seen. That said I’m reasonably well equipped to dive in with RSI. However I would definitely opt for topicalisation if time allowed ( but sticking a spray in a few times does not take a long time) and spontaneous breathing (with S-ketamine) if the… Read more »
Yes I did give a full dissociative dose and emesis occurred during the procedure. I had performed a gastric ultrasound before the procedure and the stomach was mostly collapsed so the emesis was low-volume and not a major problem (but scary). I was using a glidescope blade which can put a lot of pressure on the posterior pharynx and possibly that may be a highly emetogenic stimulus (versus a MAC blade which tends to put more pressure on the tongue base – maybe a less sensitive area with regards to vomiting). In theory, should ketamine dissociation prevent vomiting? I think… Read more »
haha love the brain “shock and awe” idea with large dose ketamine bolus. depending on the indication for using a breathing technique, if it works as you predict, with prolonged apnea (and lower likelihood of vomiting) you to some degree undermine the goal of using a breathing technique (which is to keep the patient breathing during intubation) to begin with. but there are a lot of suppositions there, Josh, not sure it would work like that. ketamine is not anti-emetic and we know from PSA literature that vomiting, especially in children is very common when ketamine is used, but this… Read more »
Just wondering . Where in the US can you find the lidocaine atomizer that you depicted in the video??
I’ve been online and haven’t found a provider.
Thanks.