FAKT

Fentanyl versus placebo with ketamine and rocuronium for patients undergoing rapid sequence intubation in the emergency department: The FAKT study—A randomized clinical trial

Ferguson I Academic Emergency Medicine, 2021; DOI: 10.1111/acem.14446

Clinical Question

• In patients requiring rapid sequence intubation (RSI) in the emergency department does the addition of fentanyl to ketamine and rocuronium reduce the frequency of patients having a systolic blood pressure (SBP) outside of a target range of 100-150mmHg?

N = 302, 5 EDs in NSW Australia

Authors’ Conclusions

• In a mixed population of adults requiring RSI in the ED the addition of fentanyl to rocuronium and ED did not reduce the incidence of an SBP outside of a target range on 100-150
• However there was an increased incidence of hypotension and reduced incidence of hypertension in the fentanyl group. Clinicians should consider postinduction haemodynamic targets before the decision to use fentanyl as a co-induction agent with ketamine

The Bottom Line

• Fentanyl, when given in a fixed ratio with ketamine, may increase the risk of peri-intubation hypotension
• I will continue to individually select the doses of induction agents based on patient characteristics and the co-induction agent used