Effect of ketamine on intracranial pressure in hydrocephalic children

Kaul, H. L.; Jayalaxmi, T S; Gode, G. R.; Mitra, Debdeep

doi:10.1111/j.1365-2044.1976.tb11853.x

Cited by 10 publications

(5 citation statements)

References 8 publications

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“…Ketamine quickly fell out of favor in the neurosurgical and anesthesia community because of initial reports of increasing ICP in these specific patient populations. These initial studies were completed in patients who were not intubated, had intracranial mass lesions or obstructive hydrocephalus, and therefore not comparable to the severe TBI population [ 13 , 14 , 22 , 23 ]. Recently, a systematic review evaluating the use of ketamine in TBI showed stability in ICP values with ketamine administration [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who are not mechanically ventilated with adequately maintained CO 2 at 35–40 mmHg might have an increase in CBF due to the slight hypoventilation induced by ketamine. This hypoventilation might lead to hypercapnia, which in turn might lead to increased ICP [ 13 , 22 , 28 ]. In addition, if a patient has intact cerebral autoregulation, the increase in CPP will lead to vasoconstriction and therefore a decrease in ICP [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury

Dengler

Karam

Barthol

et al. 2022

Critical Care Research and Practice

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Background. Increased intracranial pressure (ICP) and hypotension have long been shown to lead to worse outcomes in the severe traumatic brain injury (TBI) population. Adequate sedation is a fundamental principle in TBI care, and ketamine is an attractive option for sedation since it does not commonly cause systemic hypotension, whereas most other sedative medications do. We evaluated the effects of ketamine boluses on both ICP and cerebral perfusion pressure (CPP) in patients with severe TBI and refractory ICP. Methods. We conducted a retrospective review of all patients admitted to the neurointensive care unit at a single tertiary referral center who had a severe traumatic brain injury with indwelling intracranial pressure monitors. We identified those patients with refractory intracranial pressure who received boluses of ketamine. We defined refractory as any sustained ICP greater than 20 mmHg after the patient was adequately sedated, serum Na was at goal, and CO2 was maintained between 35 and 40 mmHg. The primary outcome was a reduction in ICP with a subsequent increase in CPP. Results. The patient cohort consisted of 44 patients with a median age of 30 years and a median presenting Glasgow Coma Scale (GCS) of 5. The median reduction in ICP after administration of a ketamine bolus was −3.5 mmHg (IQR −9 to +1), and the postketamine ICP was significantly different from baseline ( p < 0.001 ). Ketamine boluses led to an increase in CPP by 2 mmHg (IQR −5 to +12), which was also significantly different from baseline ( p < 0.001 ). Conclusion. In this single-institution study of patients with severe traumatic brain injury, ketamine boluses were associated with a reduction in ICP and an increase in CPP. This was a retrospective review of 43 patients and is therefore limited in nature, but further randomized controlled trials should be performed to confirm the findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury

Dengler

Karam

Barthol

et al. 2022

Critical Care Research and Practice

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show abstract

“…105 Early reports about ketamine dating as far back as the 1970s suggested a propensity of ketamine to cause intracranial hypertension. 106,107 However, since then, sufficient evidence has questioned this notion. Ketamine has been shown not to cause intracranial hypertension in patients, including children with traumatic brain injury.…”

Section: Contraindications Of Ketamine Usementioning

confidence: 99%

“…Early reports about ketamine dating as far back as the 1970s suggested a propensity of ketamine to cause intracranial hypertension 106,107 . However, since then, sufficient evidence has questioned this notion.…”

Section: Adverse Effects Of Ketaminementioning

confidence: 99%

A review of the clinical applications of ketamine in pediatric oncology

Prakash

Gupta

Meena

et al. 2020

Pediatric Blood & Cancer

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Ketamine is a dissociative anesthetic agent with excellent analgesic properties and a favorable safety profile. The feasibility and efficacy of various routes of administration have been established, including intravenous (IV), intramuscular (IM), oral, intranasal, rectal, and transdermal routes. The advent of newer anesthetic agents has led to a decline in the use of ketamine as an anesthetic, but its utility in short-term sedation and analgesia has expanded. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The use of topical ketamine is largely in investigational stages. Medical use of ketamine is, to a great extent, free from significant long-term neurological side effects. The objective of this review is to provide a brief account of the pharmacology of ketamine and primarily focus on the clinical applications of ketamine in pediatric oncology.

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“…109 Early reports about ketamine dating as far back as the 1970s suggested a propensity of ketamine to cause intracranial hypertension. 110,111 However, since then ample evidence has questioned this notion. Ketamine has been shown not to cause intracranial hypertension in patients, including in those with traumatic brain injury in children.…”

Section: Adverse Effectsmentioning

confidence: 99%

Ketamine in Pediatric Oncology: a drug review

Prakash¹,

Gupta²,

Meena³

2020

Preprint

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Ketamine is a dissociative anesthetic agent, with excellent analgesic properties and a favorable safety profile. Although it acts predominantly through NMDA receptor antagonism, numerous other molecular targets have been characterized, rendering antiinflammatory, anti-depressant, and thus expanding its scope for new clinical applications. The noticeable safety of ketamine in children enables its widespread use in pediatric oncology, chiefly for procedural sedation. Its value for chronic pain management in children with cancer is being increasingly recognized but requires more evidence. The topical use of ketamine is largely in investigational stages.. Rational medical use of ketamine is largely free from significant long-term neurological side effects but may have some troublesome short-term effects such as vomiting, palpitations, urinary retention, and hallucinations. This review will provide a brief account of the pharmacology of ketamine and primarily focus on the relevant aspects of ketamine in pediatric oncology.

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Effect of ketamine on intracranial pressure in hydrocephalic children

Cited by 10 publications

References 8 publications

Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury

Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure and an Increase in Cerebral Perfusion Pressure: A Retrospective Observational Study of Patients with Severe Traumatic Brain Injury

A review of the clinical applications of ketamine in pediatric oncology

Ketamine in Pediatric Oncology: a drug review

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