see also: [[Airway]] - maximise preoxygenation - eg **ketamine** 1-2mg/kg as procedural sedation to facilitate BiPAP or face mask if high risk patient cannot tolerate pre-oxygenation - ketamine best because airway reflexes and ventilation preserved **indications** - not predicted difficult airway - hypoxic/unwell and uncooperative/intolerant of preoxygenation - high risk of oxygen desaturation during apoenic period of intubation **contraindications** - predicted difficult airway -- consider awake technique instead - paediatric airway **Technique** - [[ketamine]] 1-2mg IV slow push - if SaO2 >95%: - NRB and nasal cannula at 15L/m for each device - if SaO2 <95%: - BVM with PEEP valve at 5-15 cm H2O with oral/nasal airway adjunct or CPAP-NIV 100% fiO2 5-15cm H2O - do for 3-10 min to reach adequate preoxygendation **complications** - vomiting → proceed to RSI - not improving → proceed to RSI - cannot have ketamine → consider remifentanil or droperidol 5-10mg IV