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