I enjoyed this recent article in The Journal of Trauma and Acute Care Surgery about a standardized rapid sequence intubation protocol that advocated ketamine.
Clearly, one drug for all occasions is not realistic. This is especially true if you are somewhere that does not stock ketamine. Recently, a lot of places have started stocking it and I know our AD field operators now carry it for pain control and make use of it in that algorithm. I also liked seeing the article consider rocuronium and succinylcholine as equal, although that is material for another time.
Personally, I will consider using ketamine a bit more as a sedative in RSI. I am not sure if it will replace my favorite of midazolam which is reversible, well known to me and common.
As an “occasional” intubator the key to RSI is being comfortable. There are enough potential problems with the procedure that knowing your drugs, your position and the equipment help stack the odds in your favor.