Article
Sedation of patients with acute aneurysmal subarachnoid haemorrhage with Ketamine is safe and might influence the occurrence of delayed cerebral ischemia
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Published: | June 9, 2017 |
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Objective: Ketamine has neuroprotective characteristics as well as beneficial cardiocirculatory properties and may thus reduce vasopressor consumption. In contrast, sedation with Ketamine (like any other sedative drug) has side effects. This study should assess the influence of Ketamine on the ICP, on the consumption of vasopressors in induced hypertension therapy as well as on the occurrence of DCI associated cerebral infarctions with particular focus on the complications of sedation in patients with aneurysmal subarachnoid haemorrhage (SAH).
Methods: This is a retrospective, observational study. Sixty-five patients with SAH who underwent a period of sedation were included. The clinical course variables (RASS score, ICP values, consumption of vasopressors, complications of sedation, outcome and other clinical parameters) were analyzed. Cranial CT scan imaging results were analyzed.
Results: Forty-one patients underwent sedation including Ketamine (63.1%). Ketamine lowered the ICP in 92.7% of the cases. Vasopressors could bereduced in 53.6%. DCI associated cerebral infarctions occurred significantly less often in the patient cohort being treated with sedation including Ketamine (7.3% versus 25% in the non - Ketamine group; p = 0.04). The rate of major complications was not higher in the Ketamine group. Outcome was not different regarding the groups either if they were sedated with or without Ketamine.
Conclusion: Ketamine lowers the intracranial pressure while it was not associated with a higher rate of complications. The rate of DCI associated cerebral infarctions was lower in the Ketamine group. Ketamine administration lead to a reduction of vasopressors used for induced hypertension.