Ketamine in TBI

Presented by: Pesiar Ilman

Background
• 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
• TBI. However, the drug was abandoned in the 1990s due to the suspicion
that the drug should have adverse effects on the intracranial pressure
• Recent evaluation of retrospective clinical data and case studies have
indicated that there might be a therapeutic effect of ketamine following
brain injury as it is assumed that ketamine suppresses spreading
depolarization following brain injury
"Intravenous Anesthetics." Morgan & Mikhail's Clinical
Anesthesiology, 6e Eds. John F. Butterworth IV, et al. McGraw
Hill, 2018,
Ketamine properties
• Ketamine is the best-known non-competitive N-methyl-d-aspartate receptor
antagonist (NMDA).
• Intravenous ketamine (3 mg/kg) increases global CBF by approximately
60%, but global CMRO2 does not change significantly.
• Ketamine markedly raises ICP. An increase in ICP can be blocked or
attenuated by induced hypocapnia or by administration of thiopental or
benzodiazepine
• During propofol sedation in patients with traumatic brain injury, ketamine
decreases ICP. In patients with supratentorial tumor who are anesthetized
with isoflurane (0.3% to 0.4%)/N2O 50%, ketamine 1 mg/kg did not
significantly raise ICP.
Patel P, Cottrell JE. Cottrell and Patel's Neuroanesthesia.
Elsevier; 2017.
Gregers MC, Mikkelsen S, Lindvig KP, Brøchner AC.
Ketamine as an anesthetic for patients with acute brain
injury: a systematic review. Neurocritical care. 2020 Apr
23:1-0.
 • Out of 7 evaluated the ketamine effects on ICP only 2 show increased ICP

• Only one of the seven showing increased CPP values

• 6/8 studies did not report increased MAP

Gregers MC, Mikkelsen S, Lindvig KP, Brøchner AC.

Ketamine as an anesthetic for patients with acute brain
injury: a systematic review. Neurocritical care. 2020 Apr
23:1-0.
Patel P, Cottrell JE. Cottrell and Patel's Neuroanesthesia.
Elsevier; 2017.
Gregers MC, Mikkelsen S, Lindvig KP, Brøchner AC.
Ketamine as an anesthetic for patients with acute brain
injury: a systematic review. Neurocritical care. 2020 Apr
23:1-0.
Bell JD. In vogue: ketamine for
neuroprotection in acute
neurologic injury. Anesthesia &
Analgesia. 2017 Apr
1;124(4):1237-43.
FIN