Ketamine in neurosurgical procedures

Evans, John M.; Rosen, Meghan; Weeks, Robert D.; Wise, C. C.

doi:10.1016/s0140-6736(71)80041-7

Cited by 41 publications

(25 citation statements)

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“…The notion that ketamine increases ICP stems from several case reports 15,17,25,38 and case series 11,18,30,33 published mostly between 1970 and 1972, shortly after ketamine was introduced as an anesthetic agent in the mid-1960s. Increases in ICP were observed following administration of ≥ 2-mg/kg doses of ketamine for short diagnostic or surgical procedures in awake children and adults.…”

Section: Discussionmentioning

confidence: 99%

“…These elevations were observed in patients who were breathing spontaneously, although most of the reports stress that the patients continued to breath effectively and that their arterial or end-tidal PCO 2 did not increase. 11,17,25,33,38 The ICP increased only in patients who had received ketamine as a sole anesthetic agent 11,15,17,25,30,33,38 or who were only lightly anesthetized with nitrous oxide. 18 The ICP did not increase when thiopental was administered before ketamine, and when thiopental was administered following ketamine-induced ICP elevation, ICP decreased promptly.…”

Section: Discussionmentioning

confidence: 99%

“…6,11,15,17,18,25,30,33,35,38 Anesthetics such as barbiturates, 12,33,38 benzodiazepines, 3,6 isoflurane/nitrous oxide, 26 and propofol 5 have been shown to blunt or eliminate the cerebral metabolic rate, CBF, and ICP increases associated with ketamine. We assume that this use of additional anesthetics accounts for the absence of ICP elevations following practically all ketamine administrations in our patients.…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

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

Bar-Joseph

Guilburd

Tamir

et al. 2009

PED

189

103

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

show abstract

“…[1][2][3][4][5][6][7][8][9] Many of the cited intracranial pressure values were significant-the largest increase was 1,600 mm H 2 O 9 -and alarming sequelae included apnea and bradycardia. Anesthesiologists quickly abandoned ketamine in patients with neurologic disorders, and a contraindication in settings of possible intracranial pressure elevation subsequently appeared in anesthesiology textbooks and review articles, including patients with cerebral trauma, mass, or hemorrhage.…”

mentioning

confidence: 99%