Document Detail

Effects of fentanyl and S(+)-ketamine on cerebral hemodynamics, gastrointestinal motility, and need of vasopressors in patients with intracranial pathologies: a pilot study.
MedLine Citation:
PMID:  17893578     Owner:  NLM     Status:  MEDLINE    
In neurosurgical patients, opioids are administered to prevent secondary cerebral damage. Complications often related to the administration of opioids are a decrease in blood pressure affording the use of vasopressors and intestinal atonia. One alternative approach to opioids is the application of S(+)-ketamine. However, owing to a suspected elevation of intracranial pressure (ICP), the administration of S(+)-ketamine has questioned for a long time. The aim of the present study was to evaluate ICP, gastrointestinal motility, and catecholamine consumption in neurosurgical patients undergoing 2 different protocols of anesthesia using fentanyl or S(+)-ketamine. Twenty-four patients sustaining traumatic brain injury or aneurysmal subarachnoid hemorrhage received methohexitone plus either fentanyl or S(+)-ketamine to establish a comparable level of sedation. To reach an adequate cerebral perfusion pressure (CPP), the norepinephrine dosage was adapted successively. Enteral nutrition and gastrointestinal stimulation were started directly after admission on the critical care unit. ICP, CPP, and norepinephrine dosage were recorded over 5 days and also the time intervals to full enteral nutrition and first defecation. There was no difference regarding ICP, CPP, and the time period until full enteral nutrition or first defecation between both groups. Patients who underwent analgesia with S(+)-ketamine showed a trend to a lower demand of norepinephrine compared with the fentanyl group. Our results indicate that S(+)-ketamine does not increase ICP and that its use in neurosurgical patients should not be discouraged on the basis of ICP-related concerns.
Marc D Schmittner; Susanne L Vajkoczy; Peter Horn; Thomas Bertsch; Michael Quintel; Peter Vajkoczy; Elke Muench
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  19     ISSN:  0898-4921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-25     Completed Date:  2007-11-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-62     Citation Subset:  IM    
Department of Anesthesiology and Critical Care Medicine, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
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MeSH Terms
Analgesics, Opioid*
Anesthetics, Dissociative*
Brain Injuries / physiopathology*,  surgery*
Cerebrovascular Circulation / drug effects*
Enteral Nutrition
Gastrointestinal Motility / drug effects*
Glasgow Outcome Scale
Intracranial Aneurysm / surgery
Intracranial Pressure / drug effects
Middle Aged
Neurosurgical Procedures
Norepinephrine / administration & dosage,  therapeutic use
Prospective Studies
Subarachnoid Hemorrhage / physiopathology*,  surgery*
Vasoconstrictor Agents / administration & dosage,  therapeutic use*
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Dissociative; 0/Vasoconstrictor Agents; 437-38-7/Fentanyl; 51-41-2/Norepinephrine; 6740-88-1/Ketamine

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