(1027) Etomidate Versus Ketamine for Rapid Sequence Intubation in Patients With Obesity

Introduction: Etomidate and ketamine, two sedatives used for rapid sequence intubation (RSI), each have advantages and disadvantages associated with use. Both agents are dosed based on weight, which leads to variability in dosing in patients with obesity. This may result in inadequate dosing or overdose/toxicity. The choice and dose of RSI sedative is up to provider discretion and varies based on patient and medication-related characteristics. Limited data exists regarding guidance for dosing of etomidate and ketamine for RSI in patients with obesity.

Methods: This multicenter, retrospective, observational cohort study evaluated adult patients with a body mass index (BMI) > 40 kg/m2 who received either etomidate or ketamine for RSI from January 1, 2021 to October 1, 2023. The primary outcome was post-intubation hypotension. Secondary outcomes include number of intubation attempts, first-pass successful intubation, and incidence of under-dosed or over-dosed sedative agent. Adverse effect outcomes include post-intubation hypertension, bradycardia, tachycardia, tachyarrhythmia, cardiac arrest.

Results: 400 patients were included in the study, 362 (90.5%) in the etomidate group and 38 (9.5%) in the ketamine group. The mean BMI of patients in the study is 49.6 kg/m2 ±12.5. Post-intubation hypotension occurred in 139 (38.4%) patients in the etomidate group and 17 (44.7%) patients in the ketamine group (odds ratio, 1.30; 95% confidence interval, 0.66 to 2.56; p= 0.4402).

Conclusions: This trial did not display statistically significant differences regarding post-intubation hypotension.