Ketamine is preferred for RSI in which patient condition?

• A. Healthy, normotensive patients with no comorbidities
• B. Patients with severe acute asthma only
• C. Allergic reactions to anesthesia
• D. Hemodynamically unstable patients

Answer: (D)

When choosing an induction agent for RSI in unstable patients, preserving blood pressure and perfusion is the main priority. Ketamine stands out because it tends to increase or maintain sympathetic tone, which supports blood pressure, heart rate, and cardiac output during induction. This cardiovascular stability helps prevent dangerous drops in cerebral and organ perfusion that can occur with other agents that lower blood pressure. While other situations like severe asthma can benefit from ketamine’s bronchodilatory effects, the key reason it’s preferred in this scenario is its ability to keep the patient hemodynamically stable during intubation.