Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity

Zanza, Christian; Piccolella, Fabio; Racca, Fabrizio; Romenskaya, Tatsiana; Longhitano, Yaroslava; Franceschi, Francesco; Savioli, Gabriele; Bertozzi, Giuseppe; Simone, Stefania De; Cipolloni, Luigi; Russa, Raffaele La

doi:10.3390/healthcare10030566

Cited by 12 publications

(8 citation statements)

References 59 publications

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“…Instead, ketamine can prevent indirectly acidosis because acts both as sedative and good inotropic on trauma, but its effect is very unclear in trauma induced coagulopathy. If on the one hand some studies demonstrate an inhibitory activity on platelets on the other hand it is an excellent drug for maintaining good hemodynamics and indirectly avoiding acidosis which in turn inhibits platelet function [ 94 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Zanza

Romenskaya

Racca

et al. 2023

IJMS

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Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies.

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Section: Discussionmentioning

confidence: 99%

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Zanza

Romenskaya

Racca

et al. 2023

IJMS

Self Cite

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“…Ketamine is a non-opioid analgesic that has been administered in the clinic for decades. This drug is a strong analgesic and affects the sympathetic nervous system, which can benefit trauma patients [ 40 ]. For instance, ketamine increases the average heart rate and blood pressure, which are both favorable for stabilizing the trauma patient’s condition [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The regional analgesia provided through an epidural or brachial catheter should be considered for all trauma patients; this approach can, potentially, spare the use of systemic opioids and facilitate early mobilization. Epidural analgesia has been shown to produce high levels of patient satisfaction and improve lung function after thoracoabdominal and major orthopedic surgery in elective populations [ 40 ]. We retrieve similar benefits in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Traumatic Pain in the Emergency Department

et al. 2023

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Trauma is a major cause of mortality throughout the world. Traumatic pain—acute, sudden, or chronic—is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Patients’ perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60–70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients’ estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.

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“…Emerging evidence has demonstrated that ketamine produces a state of sedation, analgesia, amnesia, retains the patient's respiratory drive and maintains the blood pressure. 11,12 A clinical trial reported better acceptance along with rapid onset and recovery along with fewer adverse effects when intranasal atomised ketamine (6 mg kg À1 ) was administered for dental procedural sedation as compared to nasal drops (6 mg kg À1 ). 13 Given its favourable sedative and anxiolytic properties, there is growing interest in the use of dexmedetomidine especially in the paediatric neurosurgical population on account of its minimal effect on respiratory rate and tidal volume.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

Hebbar K,

Reddy,

Luthra

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied. OBJECTIVE To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery. DESIGN A prospective randomised double-blind trial. SETTING A tertiary teaching hospital. PATIENTS Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery METHODS Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg−1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg−1 (Group K, n = 32) 30 min before surgery. OUTCOMES MEASURED The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (Heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted. RESULTS The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, −0.406; 95% CI, −0.621 to −0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, −0.374; 95% CI, −0.650 to 0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported. CONCLUSION Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.

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Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity

Cited by 12 publications

References 59 publications

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Acute Traumatic Pain in the Emergency Department

Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery

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