Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury

Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting

“…Thus, it is not surprising to find emergency medicine experts labeling as "myth" the belief that ketamine should not be used for induction in the setting of head injury [40]. The most recent report of ketamine's use for trauma ETI includes discussion supporting the safety of ketamine for head-injured patients [17].…”

Current Controversies in Military Pre-Hospital Critical Care

“…Since etomidate has fallen from grace [9], ketamine has emerged as the pre-hospital induction agent of choice in polytrauma and other critically ill patients [10] because of its relative cardiovascular stability and wide safe therapeutic margin. This choice is now enshrined in the MERT pre-hospital anaesthesia SOP and is gradually being adopted by civilian HEMS organisations, even in traumatic brain injury, where its use was once thought to be contra-indicated [11].…”

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

“…Succinylcholine is sometimes avoided because of the risk of malignant hyperthermia, possible ICP elevation [128], hyperkalemia, and life-threatening complications associated with unknown occult metabolic or neuromuscular disease [129,130]. Fentanyl (2-4 lg/kg) or ketamine (1-2 mg/kg) IV are alternative sedatives, and recent pediatric studies show that ketamine does not increase ICP and may be neuroprotective [131][132][133]. If hemodynamically stable, midazolam (0.1-0.2 mg/kg) can be added to any of the above combinations.…”