Best Hypnotic Drug Choice for Rapid Sequence Induction in the Operating Room

Inclusion Criteria:

* age between 18 - 80 years' old
* female\* and male

  * ≥ 1 risk factor of aspiration of gastric contents defined as
  * preoperative fasting period of less than 6 hours,
  * occlusive syndrome, functional ileus, vomiting episode within the last 12 hours,
  * orthopaedic trauma within the last 12 hours,
  * medical history of symptomatic gastroesophageal reflux or hiatus, hernia or gastroparesis or dysautonomia or gastroesophageal surgery with sphincter dysfunction)
* patient requiring orotracheal intubation during general anaesthesia in the operating room.
* patient or his/her next of kin written informed consent or emergency procedure
* failure to discontinue GLP1 analogue as recommended (exenatide, liraglutide, albiglutide, taspoglutide, lixisenatide)

Exclusion Criteria:

* predicted impossible tracheal intubation (≥ 1 of the following criteria: patient with known intubation complications, Mallampati score IV, Thyromental Distance ≤ 4.0 cm, Mouth Opening \< 3 cm, Sternomental Distance \< 12.5 cm, significant modification of the airway due to congenital, cancer, trauma or burning lesions (non-exhaustive list)) \[30\]
* preoperative arterial hypotension (MAP \< 65 mmHg or under catecholamine)
* preoperative respiratory distress syndrome (SpO2 \< 90% in room air)
* contraindications to the use of ketamine and/or propofol and/or NMB:

  * allergy to the active substance or to one of the excipients or to soy or peanuts,
  * porphyria
  * intracranial hypertension
  * uncontrolled arterial hypertension (systolic arterial pressure \> 180 mmHg)
  * personal or family history of known malignant hyperthermia, congenital muscular dystrophy, myasthenia, a known congenital deficit in plasma pseudocholinesterase
* pregnancy or breast-feeding woman
* patients under court protection or guardianship
* absence of insurance covering health costs