Anesth Analg 2005;101:524-534
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000160585.43587.5B
NEUROSURGICAL ANESTHESIA
Revising a Dogma: Ketamine for Patients with Neurological Injury?
Sabine Himmelseher, MD*, and
Marcel E. Durieux, MD, PhD
*Klinik fuer Anaesthesiologie, Klinikum rechts der Isar, Technische Universität, München, Germany; and Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
Address correspondence and reprint requests to Marcel E. Durieux, MD, PhD, Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908-0710. Address e-mail to durieux{at}virginia.edu.
We evaluated reports of randomized clinical trials in the perioperative and intensive care setting concerning ketamines effects on the brain in patients with, or at risk for, neurological injury. We also reviewed other studies in humans on the drugs 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 -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.
This article has been cited by other articles:

|
 |

|
 |
 
O. W. Sakowitz, K. L. Kiening, K. L. Krajewski, A. S. Sarrafzadeh, M. Fabricius, A. J. Strong, A. W. Unterberg, and J. P. Dreier
Preliminary Evidence That Ketamine Inhibits Spreading Depolarizations in Acute Human Brain Injury
Stroke,
August 1, 2009;
40(8):
e519 - e522.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. Aroni, N. Iacovidou, I. Dontas, C. Pourzitaki, and T. Xanthos
Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug
J. Clin. Pharmacol.,
August 1, 2009;
49(8):
957 - 964.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. L Hammell and J D Henning
Prehospital management of severe traumatic brain injury
BMJ,
May 19, 2009;
338(may19_1):
b1683 - b1683.
[Full Text]
|
 |
|

|
 |

|
 |
 
M. Gunning, Z. Perkins, and T. Quinn
Trench entrapment: is ketamine safe to use for sedation in head injury?
Emerg. Med. J.,
November 1, 2007;
24(11):
794 - 795.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. G. Bovill
Anesthetic Pharmacology: Reflections of a Section Editor
Anesth. Analg.,
November 1, 2007;
105(5):
1186 - 1190.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. R. Absalom, M. Lee, D. K. Menon, S. R. Sharar, T. De Smet, J. Halliday, M. Ogden, P. Corlett, G. D. Honey, and P. C. Fletcher
Predictive performance of the Domino, Hijazi, and Clements models during low-dose target-controlled ketamine infusions in healthy volunteers
Br. J. Anaesth.,
May 1, 2007;
98(5):
615 - 623.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Shibuta, S. Varathan, and T. Mashimo
Ketamine and thiopental sodium: individual and combined neuroprotective effects on cortical cultures exposed to NMDA or nitric oxide
Br. J. Anaesth.,
October 1, 2006;
97(4):
517 - 524.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|