Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review.
Mads Christian Tofte GregersSøren MikkelsenKatrine Prier LindvigAnne Craveiro BrøchnerPublished in: Neurocritical care (2021)
For years, the use of ketamine as an anesthetic to patients suffering from acute brain injury has been debated because of its possible deleterious effects on the cerebral circulation and thus on the cerebral perfusion. Early studies suggested that ketamine could increase the intracranial pressure thus lowering the cerebral perfusion and hence reduce the oxygen supply to the injured brain. However, more recent studies are less conclusive and might even indicate that patients with acute brain injury could benefit from ketamine sedation. This systematic review summarizes the evidence regarding the use of ketamine in patients suffering from traumatic brain injury. Databases were searched for studies using ketamine in acute brain injury. Outcomes of interest were mortality, intracranial pressure, cerebral perfusion pressure, blood pressure, heart rate, spreading depolarizations, and neurological function. In total 11 studies were included. The overall level of evidence concerning the use of ketamine in brain injury is low. Only two studies found a small increase in intracranial pressure, while two small studies found decreased levels of intracranial pressure following ketamine administration. We found no evidence of harm during ketamine use in patients suffering from acute brain injury.
Keyphrases
- brain injury
- subarachnoid hemorrhage
- cerebral ischemia
- end stage renal disease
- pain management
- blood pressure
- heart rate
- traumatic brain injury
- systematic review
- liver failure
- peritoneal dialysis
- chronic kidney disease
- case control
- prognostic factors
- randomized controlled trial
- adipose tissue
- cardiovascular disease
- intensive care unit
- respiratory failure
- type diabetes
- multiple sclerosis
- computed tomography
- blood brain barrier
- coronary artery disease
- aortic dissection
- optical coherence tomography
- patient reported outcomes
- insulin resistance
- skeletal muscle
- artificial intelligence
- functional connectivity