Document Detail

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension.
MedLine Citation:
PMID:  19569909     Owner:  NLM     Status:  MEDLINE    
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.
Gad Bar-Joseph; Yoav Guilburd; Ada Tamir; Joseph N Guilburd
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  4     ISSN:  1933-0707     ISO Abbreviation:  -     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-02     Completed Date:  2009-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  40-6     Citation Subset:  IM    
Paediatric Critical Care, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel.
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MeSH Terms
Analgesics / administration & dosage,  pharmacology*
Blood Pressure / drug effects
Brain / blood supply*,  drug effects
Cerebrovascular Circulation / drug effects*
Child, Preschool
Intensive Care Units
Intracranial Hypertension / drug therapy*,  prevention & control
Intracranial Pressure / drug effects*
Ketamine / administration & dosage,  pharmacology*
Prospective Studies
Respiratory Mechanics
Reg. No./Substance:
0/Analgesics; 6740-88-1/Ketamine
Comment In:
J Neurosurg Pediatr. 2009 Jul;4(1):37-8; discussion 38-9   [PMID:  19569908 ]

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