{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:27:23Z","timestamp":1763706443123,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ketamine use for rapid sequence intubation (RSI) is frequent in pre\u2010hospital and retrieval medicine (PHARM) and is associated with potentially deleterious haemodynamic changes, which may be ameliorated by concurrent use of fentanyl.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe the frequency with which fentanyl is used in conjunction with ketamine in a system where its use is discretionary, and to explore any observed changes in haemodynamics with its use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective observational study of over 800 patients undergoing RSI with ketamine\u2009\u00b1\u2009fentanyl in the PHARM setting between 2015 and 2019. The primary outcome was the proportion of patients in each group who had a systolic blood pressure (SBP) outside a pre\u2010specified target range, with adjustment for baseline abnormality, within 10\u00a0min of anaesthetic induction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight hundred and seventy\u2010six patients were anaesthetised with ketamine, of whom 804 were included in the analysis. 669 (83%, 95% CI 80%\u201386%) received ketamine alone, and 135 (17%, 95% CI 14%\u201320%) received both fentanyl and ketamine. Median fentanyl dose was 1.1 mcg\/kg (IQR 0.75\u20131.5 mcg\/kg). Systolic blood pressure (SBP) at induction was consistently associated with SBP after intubation in multivariable logistic regression, but fentanyl use was not associated with a change in odds of meeting the primary outcome (OR 1.08; 95% CI 0.72\u20131.60), becoming hypertensive (OR 1.35; 95% CI 0.88\u20132.07) or hypotensive (OR 0.76; 95% CI 0.47\u20131.21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The addition of fentanyl to ketamine for RSI was not associated with an alteration of the odds of post\u2010induction haemodynamic stability, although the doses used were low. These findings justify further study into the optimal dosing of fentanyl during RSI in pre\u2010hospital and retrieval medicine.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14177","type":"journal-article","created":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T15:59:20Z","timestamp":1670687960000},"page":"364-371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The effect of ketamine and fentanyl on haemodynamics during intubation in pre\u2010hospital and retrieval medicine"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5915-6315","authenticated-orcid":false,"given":"Ian M. 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