Ketamine for rapid sequence induction in patients with head injury in the emergency department

Sehdev, Rajesh; Symmons, David; Kindl, Korana

doi:10.1111/j.1742-6723.2006.00802.x

Cited by 87 publications

(58 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 However, even though a systematic review suggested that ketamine is safe for TBI victims, 39 a formal trial is needed to address this question. 40 Thus, the ideal anesthetic agent for TBI victims remains to be identified. Hohl and colleagues suggested that ''the burden of proof is to show that etomidate is as safe as other anesthetics and a noninferiority study would be needed to accomplish this.''…”

Section: Clinical Significance Of Results and Suggestions For Future mentioning

confidence: 99%

Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

Archambault

Dionne

Lortie

et al. 2012

CJEM

View full text Add to dashboard Cite

Background: Etomidate is frequently used to intubate traumatic brain injury (TBI) victims, even though it has been linked to adrenal insufficiency (AI) in some populations. Few studies have explored the risk of prolonged etomidateinduced AI among TBI victims. Objective: To determine the risk and the length of AI induced by etomidate in patients intubated for moderate and severe TBI. Methods: Participants in this observational study were moderate to severe intubated TBI victims aged $ 16 years. The anesthetic used (etomidate versus others) was determined solely by the treating emergency physician. Adrenocorticotropic hormone (ACTH) stimulation tests (250 mg) were performed 24, 48, and 168 hours after intubation. AI was defined as an increase in serum cortisol 1 hour post-ACTH test (delta cortisol) of less than 248.4 nmol/L. Results: Forty subjects (participation 42.6%) underwent ACTH testing. Fifteen received etomidate, and 25 received another anesthetic. There were no statistically significant differences between groups as to the cumulative incidence of AI at any measurement time. However, at 24 hours, exploratory post hoc analyses showed a significant decrease in delta cortisol (adjusted means: etomidate group: 305.1 nmol/L, 95% CI 214.7-384.8 versus other anesthetics: 500.5 nmol/L, 95% CI 441.8-565.7). This decrease was not present at 48 and 168 hours. Conclusion: In TBI victims, although a single dose of etomidate does not increase the cumulative incidence of AI as defined, it seems to decrease the adrenal response to an

show abstract

Section: Clinical Significance Of Results and Suggestions For Future mentioning

confidence: 99%

Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

Archambault

Dionne

Lortie

et al. 2012

CJEM

View full text Add to dashboard Cite

show abstract

“…As such, ketamine is appropriate for patients with traumatic brain injury. Moreover, given the possible impairment in cerebral auto-regulation in traumatic brain injury, the brain's perfusion pressure becomes critically dependent on mean arterial pressure, rendering a clinical scenario in which ketamine's cardiovascular stability may be beneficial [49] . Ketamine is a useful analgesic drug for use outside the operating room due to its excellent analgesia, which is similar to morphine or fentanyl, but with a lower incidence of respiratory depression, as demonstrated in pain control for patients with fractures, burns, and traumatic amputations [50,51] .…”

Section: Use Outside the Operating Roommentioning

confidence: 99%

Ketamine use in current clinical practice

2016

View full text Add to dashboard Cite

After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

show abstract

“…1 However, the evidence supporting the long-standing notion that ketamine increases ICP is rather limited, 10,11,15,17,18,25,30,32,33,38 and several other studies actually refute it. 5,6,8,22,26,35 Based on anecdotal experience, we hypothesized that ketamine does not increasebut may rather effectively decrease-ICP in patients with intracranial hypertension.…”

mentioning

confidence: 94%

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension

Bar-Joseph

Guilburd

Tamir

et al. 2009

PED

189

103

View full text Add to dashboard Cite

Object Deepening sedation is often needed in patients with intracranial hypertension. All widely used sedative and anesthetic agents (opioids, benzodiazepines, propofol, and barbiturates) decrease blood pressure and may therefore decrease cerebral perfusion pressure (CPP). Ketamine is a potent, safe, rapid-onset anesthetic agent that does not decrease blood pressure. However, ketamine's use in patients with traumatic brain injury and intracranial hypertension is precluded because it is widely stated that it increases intracranial pressure (ICP). Based on anecdotal clinical experience, the authors hypothesized that ketamine does not increase—but may rather decrease—ICP. Methods The authors conducted a prospective, controlled, clinical trial of data obtained in a pediatric intensive care unit of a regional trauma center. All patients were sedated and mechanically ventilated prior to inclusion in the study. Children with sustained, elevated ICP (> 18 mm Hg) resistant to first-tier therapies received a single ketamine dose (1–1.5 mg/kg) either to prevent further ICP increase during a potentially distressing intervention (Group 1) or as an additional measure to lower ICP (Group 2). Hemodynamic, ICP, and CPP values were recorded before ketamine administration, and repeated-measures analysis of variance was used to compare these values with those recorded every minute for 10 minutes following ketamine administration. Results The results of 82 ketamine administrations in 30 patients were analyzed. Overall, following ketamine administration, ICP decreased by 30% (from 25.8 ± 8.4 to 18.0 ± 8.5 mm Hg) (p < 0.001) and CPP increased from 54.4 ± 11.7 to 58.3 ± 13.4 mm Hg (p < 0.005). In Group 1, ICP decreased significantly following ketamine administration and increased by > 2 mm Hg during the distressing intervention in only 1 of 17 events. In Group 2, when ketamine was administered to lower persistent intracranial hypertension, ICP decreased by 33% (from 26.0 ± 9.1 to 17.5 ± 9.1 mm Hg) (p < 0.0001) following ketamine administration. Conclusions In ventilation-treated patients with intracranial hypertension, ketamine effectively decreased ICP and prevented untoward ICP elevations during potentially distressing interventions, without lowering blood pressure and CPP. These results refute the notion that ketamine increases ICP. Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can possibly be used safely in trauma emergency situations.

show abstract

Ketamine for rapid sequence induction in patients with head injury in the emergency department

Abstract: In the modern acute management of head-injured patients, ketamine might be a suitable agent for induction of anaesthesia, particularly in those patients with potential cardiovascular instability.

Cited by 87 publications

References 67 publications

Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims

Ketamine use in current clinical practice

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension

Contact Info

Product

Resources

About