A middle-aged male Pt presented to the ED at 3 am c/o acute angioedema of the tongue. The pt noted the swelling at ~2am after waking up, and came to the ED after the condition progressively worsened. PMHx and previous episodes of condition are unknown. Treatment with epinephrine was unsuccessful, and conscious nasotrachael intubation with 6.0 french was performed for airway management without incident. Anaesthetic spray (4% lidocaine) and ketamine (1-2 mg/kg) administered.
Ketamine is an NDMA receptor agonist and GABA receptor stimulator working to induce and maintain anesthesia. Ketamine is commonly used for “awake” intubations because it preserves the pt’s respiratory drive while inducing a trance-like state that induces memory loss and pain relief. Furthermore, ketamine is commonly used with hypotensive pts as it is a sympathetic nervous system stimulator.