trauma-list Digest, Vol 50, Issue 5

[IVAN HRONEK]

Revising a dogma: ketamine for patients with neurological injury?Himmelseher S - Anesth Analg - 01-AUG-2005; 101(2): 524-34, table of contents
 
We evaluated reports of randomized clinical trials in the perioperative and intensive care setting concerning ketamine's effects on the brain in patients with, or at risk for, neurological injury. We also reviewed other studies in humans on the drug's effects on the brain, and reports that examined ketamine in experimental brain injury. In the clinical setting, level II evidence indicates that ketamine does not increase intracranial pressure when used under conditions of controlled ventilation, coadministration of a gamma-aminobutyric acid (GABA) receptor agonist, and without nitrous oxide. Ketamine may thus safely be used in neurologically impaired patients. Compared with other anesthetics or sedatives, level II and III evidence indicates that hemodynamic stimulation induced by ketamine may improve cerebral perfusion; this could make the drug a preferred choice in sedative regimes after brain injury. In the laboratory, ketamine has neuroprotective, and S(+)-ketamine additional neuroregenerative effects, even when administered after onset of a cerebral insult. However, improved outcomes were only reported in studies with brief recovery observation intervals. In developing animals, and in certain brain areas of adult rats without cerebral injury, neurotoxic effects were noted after large-dose ketamine. These were prevented by coadministration of GABA receptor agonists. IMPLICATIONS: Ketamine can be used safely in neurologically impaired patients under conditions of controlled ventilation, coadministration of a {gamma}-aminobutyric acid receptor agonist, and avoidance of nitrous oxide. Its beneficial circulatory effects and preclinical data demonstrating neuroprotection merit further animal and patient investigation.
Citation:IH

> Date: Fri, 3 Aug 2007 20:53:11 -0400> From: stephen.richey at gmail.com> To: trauma-list at trauma.org> Subject: Re: trauma-list Digest, Vol 50, Issue 5> > "There is no reason to use ketamine when the preponderance of the world's> literature says it isn't safe."> > What's strange is that if you look at the actual literature, the journal> articles specifically, there are quite a few, dating back to the 1970's that> state that it does not raise ICP in numerous settings (including> neurosurgical patients), and there is more recent literature indicating it> actually has neuroprotective effects to some degree (although the later is> still being debated because it is largely based on limited studies in> rabbits and other small mammals). If anyone wants these articles, please> contact me off list as I have them on my hard drive (I'm slowly working on a> lit review on the subject) and will send them to anyone who is interested.> > To be quite honest, I'm beginning to wonder where the evidence for the> admonition not to use it in head trauma patients is because it doesn't seem> to be very easily found. Of course, I'm just an RT, what the hell do I> know.......> > > -- > Stephen L. Richey, CRT> > "It is better to know some of the questions than all of the answers."- James> Thurber> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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Subject: Revising a Dogma: Ketamine for Patients with Neurological Injury? --
	Himmelseher and Durieux 101 (2): 524 -- Anesthesia & Analgesia
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