Ketamine Induced Hypotension

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Steve Haywood
Former Respiratory Therapist working to de-mystify the ventilator through hands-on workshops and online education. Additional interests include HFNC in CHF and COPD, Medical Education, and Tupperware.

The Pre-brief

We all know that ketamine can increase blood pressure. However, in the hemodynamically fragile patient ketamine can induce hypotension. Here we will break down how ketamine can induce hypotension. 

The De-brief

  • Ketamine is still a strong choice for the induction of a hemodynamically fragile patient. 
  • Ketamine can increase blood pressure by inhibiting the catecholamine reuptake channels.
  • If the catecholamine supplies are exhausted or the receptors are desensitized this inhibition may not matter.
  • In this hemodynamically fragile patient we should always anticipate post intubation hypotension regardless of what induction agent we are use.
  • Preparation for post intubation hypotension should include obtaining good IV access, resuscitating before intubating, and setting the BP cuff to cycle frequently. 


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