Zuin M, et al. - This study assessed the differential impacts of ketamine or midazolam, as induction agent, on the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI). A significant PIH was more likely in patients who received midazolam versus ketamine as an induction agent for RSI.

Methods

• Researchers reviewed 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).
• 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)].  

Results

• A total of 136 patients (66 male and 70 females, mean age 72.25 ± 7.33 years) met the inclusion criteria over the study period.
• Data reported that patients treated with midazolam and ketamine were 63 and 73, respectively.
• Researchers observed PIH in 38 (27.9%) patients after 10 min from ETI.
• They also noted that 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).
• In addition, findings demonstrated that 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.