Sedation of Patients with Acute Aneurysmal Subarachnoid Hemorrhage with Ketamine Is Safe and Might Influence the Occurrence of Cerebral Infarctions Associated with Delayed Cerebral Ischemia

Brelie, Christian von der; Seifert, Michael; Rot, Sergej; Tittel, A.; Sanft, C.; Meier, Ullrich; Lemcke, Johannes

doi:10.1016/j.wneu.2016.09.121

Cited by 31 publications

(37 citation statements)

References 29 publications

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“…German national guidelines [6] comment amply about the use of ketamine in patients with TBI and IHTN; most of their recommendations are classified as "could do", and do not have a binding character. Nonetheless, there is emerging data in the literature advocating for the use of ketamine in aSAH [23,24], as it has been associated with a lower incidence of DCI-related infarctions and lower ICP in aSAH patients. Interestingly, LVC resort to clonidine for the deepening of sedation.…”

Section: Sedation Deepeningmentioning

confidence: 99%

Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey

et al. 2020

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Objective: Current evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage (aSAH) focus primarily on timing, modality and technique of aneurysm occlusion, and on prevention and treatment of delayed cerebral ischemia. Significant aspects of management in the intensive care unit (ICU) during the later course of aSAH such as ventilation and sedation (VST) remain unaddressed. aSAH patients present unique challenges not accounted for in general ICU recommendations and guidelines, which is why we attempted to further characterize ICU practices in aSAH patients in Germany. Methods: We conducted a nationwide survey on ICU practices in aSAH in Germany. Secondarily, we assessed the existence of and compliance with current guidelines regarding ICU practices. The questionnaire was designed in interdisciplinary fashion and distributed online through the kwiksurvey ® platform (Bristol, UK). Results: A total of 50 responses were received, accounting for a response rate of 49%. Twenty-one were university hospitals (UH), 23 high-volume centers (HVC), 6 low-volume centers (LVC). Half of the participating centers do not take into consideration WFNS at presentation to indicate ventilation. While 42% of centers rely on the P/F ratio to indicate ventilation, 62% of them have a cutoff value of < 200, and 38% of < 100. While most UH and HVC used propofol for the first phase of sedation (95%), LVC employed benzodiazepines (100%). Sedation deepening was done with ketamine in UH (75%) and HVC (60%), whereas LVC used predominantly clonidine (100%). Conclusions: Our study clearly demonstrates that attitudes and practices pertaining to ICU management in aSAH are enormously heterogeneous, reflecting the lack of good quality evidence and differing interpretations thereof.

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Section: Sedation Deepeningmentioning

confidence: 99%

Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey

et al. 2020

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“…In the 9 patients, S-ketamine > 2 mg/kg BW/h did not lead to significant creatinine changes overall (before S-ketamine, 0.65 ± 0.17 mg/dl; during high-dose S-ketamine, 0.68 ± 0.18 mg/dl; paired t test; P = 0.443). It should be taken into account that ketamine, in addition to its potentially beneficial effects on spreading depolarizations [7], also leads to reduction in ICP and to savings in catecholamines with potential kidney protection [8]. Nonetheless, although our data do not suggest that Sketamine increases the risk for AKI, renal function should be closely monitored.…”

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confidence: 75%

High doses of ketamine to improve neuronal edema in subarachnoid hemorrhage: we should consider other undesirable organ targets

et al. 2020

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“…One patient in our series was treated with therapeutic hypothermia, which produced favorable control of the ICP, but could not prevent cerebral infarction. Other treatment modalities described in the literature are anesthesia of the stellate ganglion, 30 aortic balloon, 31 immunosuppressants, 32 continuous intra-arterial nimodipine, 33 and ketamine, 34 but further studies are required. 35 Limitations of the present study are its small sample size and its retrospective design.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Findings in Refractory Delayed Cerebral Ischemia

González

Ruiz²,

Mura³

2019

Arq Bras Neurocir

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Background Delayed cerebral ischemia (DCI) follows a refractory course in a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH), leading to diffuse ischemic injury. The role of angiographic vasospasm (AV) is unknown. Our goal is to study the angiographic alterations and the clinical profile of refractory DCI patients. Methods Retrospective study of patients with SAH who presented with DCI treated with medical and endovascular therapy, with a refractory evolution, defined as multiple ischemic infarction and brain death. Results Out of a cohort of 336 patients, 7 (2%) developed refractory DCI. The median age of the patients was 48 (38–60) years old. Five patients had ruptured anterior communicating artery (ACoA) aneurysms. Four patients were treated with coil embolization, and three with microsurgical clipping. Angiographic vasospasm was classified as severe in 5 cases. Compromise of bilateral circulation was detected in six patients. Distal circulation vasospasm occurred in five cases. Slow circulatory transit times were observed in three patients. Conclusion Angiographic findings such as bilateral circulatory compromise and distal vasospasm were frequent alterations. Further studies are required to establish the association of these findings with the clinical outcomes.

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Sedation of Patients with Acute Aneurysmal Subarachnoid Hemorrhage with Ketamine Is Safe and Might Influence the Occurrence of Cerebral Infarctions Associated with Delayed Cerebral Ischemia

Cited by 31 publications

References 29 publications

Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey

Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey

High doses of ketamine to improve neuronal edema in subarachnoid hemorrhage: we should consider other undesirable organ targets

Angiographic Findings in Refractory Delayed Cerebral Ischemia

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