Podcast 689: Peri-Intubation Hypotension

<p><strong>Contributor: Ricky Dhaliwal, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Hypotension in patients requiring intubation should be resuscitated as much as possible</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Phenylephrine can be given via push doses to  increase blood pressure from  alpha agonism</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">For sedation, avoid propofol with hypotension and opt for etomidate or ketamine</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">April MD, Arana A, Schauer SG, et al. Ketamine Versus Etomidate and Peri-intubation Hypotension: A National Emergency Airway Registry Study. Acad Emerg Med. 2020;27(11):1106-1115. doi:10.1111/acem.14063</span></p> <p><span style="font-weight: 400;">Panchal AR, Satyanarayan A, Bahadir JD, Hays D, Mosier J. Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension. J Emerg Med. 2015;49(4):488-494. doi:10.1016/j.jemermed.2015.04.033</span></p> <p><span style="font-weight: 400;">Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multi-center study. Crit Care Med. 2006;34:2355–61.</span></p> <p><em><span style="font-weight: 400;">Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD</span></em></p> <p><em><span style= "font-weight: 400;">*********************</span></em></p> <p><br /> <br /></p>