Ketamine vs. etomidate - vasodil vs. vasoconst.

[IVAN HRONEK]

August 3, 2007 GMT 
 






Acute management of Traumatic Brain Injury
Editor, November 28, 2006
 
 
 If there are signs of impending transtentorial herniation (unilateral posturing and/or unilateral dilated pupil) or if there is rapid progressive neurological deterioration (without extracranial cause), then there is significant intracranial hypertension and measures should be instituted to control ICP immediately.
 
Hypoxia and hypotension are the greatest threat to functional outcome in brain injury. Early acute control of the above three parameters may have more impact than all other measures subsequently employed.
 
Other injuries causing haemorrhage must be addressed first (or simultaneously) so that an adequate cerebral perfusion pressure is maintained.
 
Thanks Mathias for the above article, from which i cut a few excerpts.  
 
Ketamine vs. etomidate choice depends also on whether or not you are facing hypotension: CPP has to be maintained and if the pts. pupils are symmetrical perhaps it would be better to increase CBF with the Ketamine. 
 
Conversely, if there is unilateral pupil dilatation or "rapid neurological deterioration" use Etomidate as herniation may be pending.
Ivan       


> Date: Fri, 3 Aug 2007 17:59:58 +0200> From: listen at doc-kalkum.de> To: trauma-list at trauma.org> Subject: Re: Ketamine - disadvantages in trauma pts.> > Ivan e.a.,> > - snip - > > > > Ketamine increases cerebral metabolism, CBF, and ICP. Because of its excitatory CNS effects, which can be detected by generalized EEG development of theta-wave activity,[463] as well as by petit mal seizure-like activity in the hippocampus,[482] ketamine increases CMRO2.> - snip -> > the issue of whether ketamin is a suitable agent in the field for trauma> patients, especially in the group of those with head injuries, turns up> every year or two in this group. To make a long story short: the> "disadvantages of ketamin" in trauma are a remnant in barely actualised> textbooks. Outside of these the drug is used for decades in many> countries of the world, has (at least in small series and reports) been> proved to be as well safe and effective and is actually recommended as> safe in the treatment of skull / head / braintrauma. Thus it has made> it's way in the current guidelines at least in my country> (http://www.uni-duesseldorf.de/WWW/AWMF/ll/030-076.htm).> > Maybe we should add a small chapter on drugs in braintrauma to this> page: http://www.trauma.org/index.php/main/article/392/> > Cheers!> > Mathias> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/