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Ketamine and midazolam differently impact post-intubation hemodynamic profile when used as induction agents during emergency airway management in hemodynamically stable patients with ST elevation myocardial infarction

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Abstract

We investigated the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI) and medicated with ketamine or midazolam as induction agent. STEMI patients admitted between 1st January 2009 and 1st January 2017 who did not receive any type of inotropic support before the endotracheal intubation (ETI) was reviewed. PIH was defined as a reduction greater than 20% or a drop of systolic blood pressure (SBP) below 90 mmHg within 10 min from the administration of the induction agent [ketamine (1 mg/kg) or midazolam (0.3 mg/kg)]. Over the study period, 136 patients (66 male and 70 females, mean age 72.25 ± 7.33 years) met the inclusion criteria. Patients treated with midazolam and ketamine were 63 and 73, respectively. PIH was observed in 38 (27.9%) patients after 10 min from ETI. Midazolam patients had a significant lower SBP at both 5 and 10 min after induction (97.75 ± 8.06 vs 100.81 ± 8.08, p = 0.029 and 92.83 ± 7.53 vs 101.58 ± 7.29, p < 0.0001, respectively) (ANOVA p < 0.0001). Age (OR 1.91, 95% CI 1.87–1.97, p = 0.001), history of arterial hypertension (OR 2.27, 95% CI 2.21–2.35, p = 0.0001), multivessel coronary artery disease (OR 2.66, 95% CI 2.58–2.71, p = 0.001), SI ≥0.9 (OR 2.41, 95% CI 2.36–2.48, p < 0.0001) and anterior STEMI (OR 2.51, 95% CI 2.48–2.57, p = 0.0001) resulted independent predictors of PIH in STEMI patients treated with midazolam, as induction agent, before ETI. Midazolam was more likely than ketamine to cause significant PIH when used as an induction agent for RSI in hemodynamically stable patients with STEMI.

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  1. Marco Zuin and Gianluca Rigatelli equally contribute to the manuscript.

Authors and Affiliations

  1. Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy

    Marco Zuin

  2. Department of Cardiology, Rovigo General Hospital, Rovigo, Italy

    Marco Zuin, Luca Conte, Sara Giatti & Loris Roncon

  3. Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy

    Gianluca Rigatelli & Fabio Dell’Avvocata

  4. Department of Cardiac Surgery, University of Verona, Verona, Italy

    Giuseppe Faggian

  5. Department of Anaesthesiology, Rovigo General Hospital, Rovigo, Italy

    Flavio Michielan

  6. Department of Cardiology, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy

    Loris Roncon

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  1. Marco Zuin
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Correspondence to Loris Roncon.

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Zuin, M., Rigatelli, G., Dell’Avvocata, F. et al. Ketamine and midazolam differently impact post-intubation hemodynamic profile when used as induction agents during emergency airway management in hemodynamically stable patients with ST elevation myocardial infarction. Heart Vessels 33, 213–225 (2018). https://doi.org/10.1007/s00380-017-1049-5

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  • DOI: https://doi.org/10.1007/s00380-017-1049-5

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