Effect of Etomidate and Ketamine on Optic Nerve Sheath Diameter in severe Traumatic Brain Injury patients undergoing Rapid Sequence Intubation in Emergency Department: ARandomized Controlled Trial.

Traumatic Brain Injury(TBI) has been one of the leading causes of morbidity and mortality all around the. world. During airway management in TBI, there are chances of an increase in Intracranial pressure (ICP) due to intubation, hypoxia, and hemodynamic instability.ICP is highly dynamic and changes instantly during intubation. In the literature, there is no specific drug that provides ideal incubating conditions for acute TBI patients. To provide sedation before the procedure Etomidate has long been the drug of choice. However, Etomidate

causes adrenal suppression and increases the risk of morbidity and mortality. Ketamine has emerged as a drug of choice in many such patients recently since it does not cause hypotension, has analgesic properties and its cerebral protection effect is being studied. Ultrasonography of optic nerve sheath diameter (ONSD) has been correlated with an increase in ICP as an optic nerve sheath. However, there are no studies in the literature comparing the efficacy of these drugs on ICP changes in acute TBI patients. This study will compare both these drugs and provide a better option of induction agent for rapid sequence intubation in traumatic brain injury patients.