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Revising a Dogma: Ketamine for Patients with Neurological Injury?

Sabine Himmelseher, Marcel E. Durieux

Anesthesia & Analgesia July 12, 2005 DOI: 10.1213/01.ane.0000160585.43587.5b (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Review Randomized Peer reviewed
Population Neurologically impaired patients (perioperative and intensive care setting)
Intervention Ketamine
Topics Ketamine Esketamine
Keywords Anesthesia Traumatic brain injury Agonist Neuroprotection Cerebral perfusion pressure Pharmacology Cerebral blood flow Receptor
Citations 305
Key findings Ketamine can be safely used in neurologically impaired patients under controlled ventilation, coadministration of a GABA receptor agonist, and avoidance of nitrous oxide, and may improve cerebral perfusion.

Abstract

UNLABELLED: 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.

Comparable studies

Other narrative reviews on ketamine, most cited first.

Study Year Design Participants
Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms 2018 Review
Mechanisms of Ketamine Action as an Antidepressant 2018 Review
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression 2021 Review
Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) 2013 Review
A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders 2017 Review and consensus statement

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