Alfentanil versus fentanyl with ketamine for emergency department rapid sequence intubation: The A-FAKT study, a randomised clinical trial.

When a patient in an emergency department needs a breathing tube placed urgently — a procedure called rapid sequence intubation — doctors use a combination of medications to keep the patient unconscious and relax their muscles. One part of that drug combination is an opioid (a morphine-like medicine) used to help stabilise blood pressure during the procedure. Currently, fentanyl is the most commonly used opioid for this purpose, but a related drug called alfentanil may actually work better due to how quickly it acts. This randomised clinical trial is comparing fentanyl and alfentanil head-to-head when used alongside ketamine (a sedative) and rocuronium (a muscle relaxant). Patients will be randomly assigned to receive one or the other without the medical team knowing which was given, so the results can be compared fairly. You may be eligible if you are an adult (18 or older) who requires urgent intubation in an emergency department where the treating doctor plans to use an opioid with ketamine and rocuronium. People with severe low blood pressure, allergies to the study drugs, or COVID-19 infection are not eligible.