Ketamine and Intracranial Pressure: No Contraindication Except Hydrocephalus

Green, Steven M.; Andolfatto, Gary; Krauss, Baruch

doi:10.1016/j.annemergmed.2014.08.025

Cited by 49 publications

(27 citation statements)

References 23 publications

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“…Ketamine is well known for its ability to stabilize and even stimulate the circulatory system compared to most intravenous anesthetics [3]. Its use in treatment of patients suffering from TBI or other conditions with the risk of elevated ICP have been debated since the 1960s after several studies found that ketamine contributed to an elevation in ICP [25]. In this systematic review, only two prospective studies [19,20] showed elevated ICP during ketamine use.…”

Section: Cerebral Circulationmentioning

confidence: 87%

Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review

et al. 2020

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For years, the use of ketamine as an anesthetic to patients suffering from acute brain injury has been debated because of its possible deleterious effects on the cerebral circulation and thus on the cerebral perfusion. Early studies suggested that ketamine could increase the intracranial pressure thus lowering the cerebral perfusion and hence reduce the oxygen supply to the injured brain. However, more recent studies are less conclusive and might even indicate that patients with acute brain injury could benefit from ketamine sedation. This systematic review summarizes the evidence regarding the use of ketamine in patients suffering from traumatic brain injury. Databases were searched for studies using ketamine in acute brain injury. Outcomes of interest were mortality, intracranial pressure, cerebral perfusion pressure, blood pressure, heart rate, spreading depolarizations, and neurological function. In total 11 studies were included. The overall level of evidence concerning the use of ketamine in brain injury is low. Only two studies found a small increase in intracranial pressure, while two small studies found decreased levels of intracranial pressure following ketamine administration. We found no evidence of harm during ketamine use in patients suffering from acute brain injury.

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Section: Cerebral Circulationmentioning

confidence: 87%

Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review

et al. 2020

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“…There have been concerns about ketamine causing increased intercranial pressure (ICP) since the initial reports of patient's suffering increased ICP came out during the 1970's. Ketamine was stigmatized and medical literature from then on contraindicated the use of ketamine for patients with neurological disorders [31]. Upon re-examination of the 1970's studies reporting the increased ICP it was found that the patients requiring intervention all had preexisting hydrocephalus with no intact cerebral spinal fluid flow [31].…”

Section: Considerations For Practitioners and Nursesmentioning

confidence: 99%

“…Ketamine was stigmatized and medical literature from then on contraindicated the use of ketamine for patients with neurological disorders [31]. Upon re-examination of the 1970's studies reporting the increased ICP it was found that the patients requiring intervention all had preexisting hydrocephalus with no intact cerebral spinal fluid flow [31]. The increase in ICP is caused by increased blood flow due to cerebral vasodilation, preserving or improving cerebral perfusion [20] [31].…”

Section: Considerations For Practitioners and Nursesmentioning

confidence: 99%

“…Upon re-examination of the 1970's studies reporting the increased ICP it was found that the patients requiring intervention all had preexisting hydrocephalus with no intact cerebral spinal fluid flow [31]. The increase in ICP is caused by increased blood flow due to cerebral vasodilation, preserving or improving cerebral perfusion [20] [31]. Therefore increased ICP is only contraindicated in use for patients with preexisting hydrocephalus.…”

Section: Considerations For Practitioners and Nursesmentioning

confidence: 99%

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Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

Kestenian¹,

Gantioque²,

Snyder³

2020

OJEM

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The use of opioid analgesics has created an opioid addiction epidemic in the United States and around the world. One of the main responsibilities of the emergency department is to address acute pain. In this paper we examine the use of low dose ketamine as a safe substitute for opioid analgesics. Types of pain are identified using prior established taxonomy, followed by discussing types of management and treatments. The opioid epidemic and its societal implications are considered. We also examine the side effects of ketamine and the use of ketamine as an adjunct to analgesics used for pain control. Recommendations and considerations for the use of ketamine are suggested, and a low dose ketamine administration sample hospital policy is reviewed.

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“…Relative contraindications include active respiratory infections, previous airway surgery, porphyria, thyroid disorders and cardiovascular diseases . Recent evidence demonstrated that ketamine had a negligible effect on intracranial pressure and maintained cerebral perfusion pressure in both the traumatic and non‐traumatic setting. Ketamine has historically been thought to increase intraocular pressure; however, Wadia et al .…”

Section: Pharmacological Sedationmentioning

confidence: 99%

Paediatric procedural sedation within the emergency department

Krieser

Kochar

2016

J Paediatrics Child Health

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Procedural sedation and analgesia in children requires the use of non-pharmacological and pharmacological approaches to facilitate the management of painful procedures. The development of skills in such techniques has mirrored the development of paediatric emergency medicine as a subspecialty. Governance, education and credentialing must facilitate safe sedation practice, using a structured approach, as sedating children in the busy environment of an emergency department is not without risk. Emergency clinicians, patients and caregivers all have a role to play in developing a safe, effective sedation plan.

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Ketamine and Intracranial Pressure: No Contraindication Except Hydrocephalus

Cited by 49 publications

References 23 publications

Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review

Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review

Low Dose Ketamine Used for Acute Pain Management in the Emergency Department

Paediatric procedural sedation within the emergency department

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