Analgosedation of adult patients with elevated intracranial pressure

Herzer, Guenther; Illievich, U. M.; Voelckel, Wolfgang G.; Trimmel, Helmut

doi:10.1007/s00508-017-1228-5

Cited by 8 publications

(9 citation statements)

References 31 publications

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“…An ideal drug for analgosedation should exhibit rapid onset and cessation of action for optimum control, be freed from active metabolites and cardiovascular side effects and the lowest possible tendency to cause delirium. The pharmacokinetic and pharmacodynamic properties of S(+)-ketamine already described come very close to these ideals, so that it plays a central role in a state of the art, analgesia-based sedation concept both for short-term and longer-term use and in patients with a number of particular conditions [47]. …”

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

“…In patients sedated for longer periods it is regularly used in combination with other substances [47], particularly with sedatives such as midazolam, propofol and clonidine. It is also often combined with opioid analgesics such as remifentanil.…”

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

“…S(+)-ketamine has a special value as an additive drug in analgosedation of intensive care patients and if possible, should be part of the treatment concept from the onset. In patients sedated for longer periods it is regularly used in combination with other substances [ 47 ], particularly with sedatives such as midazolam, propofol and clonidine. It is also often combined with opioid analgesics such as remifentanil.…”

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

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S(+)-ketamine

Trimmel

Helbok

Staudinger

et al. 2018

Wien Klin Wochenschr

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SummaryS(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

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Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

See 1 more Smart Citation

S(+)-ketamine

Trimmel

Helbok

Staudinger

et al. 2018

Wien Klin Wochenschr

Self Cite

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“…In patients requiring sedation for longer than 7 days, propofol should be discontinued due to the risk of “propofol infusion syndrome” at doses > 4 mg/kg/h ( 15 , 16 , 20 ). This syndrome is characterized by rhabdomyolysis, green urine, elevated hepatic enzymes, and elevated triglycerides ( 127 ). In summary, a combined regimen of propofol (3 mg/kg/h), to reduce oxygen consumption and ensure suppression of seizures, and fentanyl (1–2 μg/kg/h), to facilitate patient-ventilator synchrony, could be recommended.…”

Section: Tapering Therapies After the Control Of Intracranial Hypertementioning

confidence: 99%

Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury

et al. 2020

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Severe traumatic brain injury (TBI) is frequently associated with an elevation of intracranial pressure (ICP), followed by cerebral perfusion pressure (CPP) reduction. Invasive monitoring of ICP is recommended to guide a step-by-step “staircase approach” which aims to normalize ICP values and reduce the risks of secondary damage. However, if such monitoring is not available clinical examination and radiological criteria should be used. A major concern is how to taper the therapies employed for ICP control. The aim of this manuscript is to review the criteria for escalating and withdrawing therapies in TBI patients. Each step of the staircase approach carries a risk of adverse effects related to the duration of treatment. Tapering of barbiturates should start once ICP control has been achieved for at least 24 h, although a period of 2–12 days is often required. Administration of hyperosmolar fluids should be avoided if ICP is normal. Sedation should be reduced after at least 24 h of controlled ICP to allow neurological examination. Removal of invasive ICP monitoring is suggested after 72 h of normal ICP. For patients who have undergone surgical decompression, cranioplasty represents the final step, and an earlier cranioplasty (15–90 days after decompression) seems to reduce the rate of infection, seizures, and hydrocephalus.

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“…This hinders the implementation of NWTs in many NICUs. 68 Future studies should define which subgroup of patients might benefit from NWTs and in which the risks outweigh the potential benefits.…”

Section: Neurological Wake-up Testmentioning

confidence: 99%

Sedation During Neurocritical Care

Vanaclocha

Chisbert

Quilis

et al. 2019

Journal of Neuroanaesthesiology and Critical Care

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Sedation is an essential therapeutic strategy in the care of neurocritical patients. Intravenous sedative agents are the most widely used, with promising alternatives (dexmedetomidine, ketamine, and volatile agents) to propofol and midazolam arising. Studies designed to evaluate superiority and avoid biases are required. A neurological awakening test is safe in most patients. Potential risks and benefits of limiting deep sedation and daily interruption of sedation in these patients remain unclear. The aim of this review was to report recent clinical evidence on sedation in this subgroup of patients, focusing on its effects on clinical prognosis.

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Analgosedation of adult patients with elevated intracranial pressure

Abstract: We found good general compliance with the recommendations of the current S3 guidelines. Room for improvement exists in monitoring and the use of scores to detect delirium.

Cited by 8 publications

References 31 publications

S(+)-ketamine

S(+)-ketamine

Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury

Sedation During Neurocritical Care

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