The effect of ketamine and fentanyl on haemodynamics during intubation in pre-hospital and retrieval medicine

Ian M. C. Ferguson*, Matthew R. Miller, Christopher Partyka, James Bliss, Anders Aneman, Ian A. Harris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
1 Downloads (Pure)


Background: Ketamine use for rapid sequence intubation (RSI) is frequent in pre-hospital and retrieval medicine (PHARM) and is associated with potentially deleterious haemodynamic changes, which may be ameliorated by concurrent use of fentanyl. Objectives: 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. Methods: A retrospective observational study of over 800 patients undergoing RSI with ketamine ± fentanyl 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-specified target range, with adjustment for baseline abnormality, within 10 min of anaesthetic induction. Results: Eight hundred and seventy-six patients were anaesthetised with ketamine, of whom 804 were included in the analysis. 669 (83%, 95% CI 80%–86%) received ketamine alone, and 135 (17%, 95% CI 14%–20%) received both fentanyl and ketamine. Median fentanyl dose was 1.1 mcg/kg (IQR 0.75–1.5 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 0.72–1.60), becoming hypertensive (OR 1.35; 95% CI 0.88–2.07) or hypotensive (OR 0.76; 95% CI 0.47–1.21). Conclusions: The addition of fentanyl to ketamine for RSI was not associated with an alteration of the odds of post-induction haemodynamic stability, although the doses used were low. These findings justify further study into the optimal dosing of fentanyl during RSI in pre-hospital and retrieval medicine.

Original languageEnglish
Pages (from-to)364-371
Number of pages8
JournalActa Anaesthesiologica Scandinavica
Issue number3
Publication statusPublished - Mar 2023
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • fentanyl
  • intubation
  • ketamine


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