Usually the use of ketamine for patients with traumatic brain injuries is contraindicated due to the concerns of increasing intracranial pressure. However, these concerns came from early studies and case reports that were improperly controlled and designed. Recently, there were studies done which challenge the use of ketamine being safe to use in these patients.
What is the Goal of the Study?
The purpose of the study was to review the use of ketamine for induction, sedation and maintenance in patients with a traumatic brain injury in different clinical settings associated with anesthesia. Researchers also wanted to review the potential mechanisms underlying the neuroprotective properties associated with ketamine.
Results of the Study:
While the population of the particular study was very specific and limited to trauma patients, of the 101 adults and 55 pediatric patients studied, intracranial pressure did not increase in any of the studies described and in three patients it actually fell. There is an Oxford study which showed that ketamine did not increase intracranial pressure in severe traumatic brain injury patients that are both ventilated and sedated, and in fact it lowers pressure in certain cases.
Conclusion to the Study:
Many small studies have started to address intracranial pressure changes with the use of ketamine infusions, but these must be interpreted with great caution. Opponents of the drug say ketamine could cause an increase in intracranial pressure through sympathetic stimulation and it could make traumatic brain injury patients condition worse. Studies which suggest ketamine elevates intracranial pressure is weak, and evidence it is harmful may be weaker.
Researchers believe ketamine is an appropriate induction agent for intubation for patients with normal blood pressure or hypotension. For patients with hypertension and an elevated blood pressure with suspected increased intracranial pressure, ketamine should be avoided because it tends to raise blood pressure.
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