Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last 20 years, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, partially due to the favorable effects on haemodynamics.
However a new application of ketamine is now being explored – whether ketamine may be able to reduce secondary brain injury.
In this talk, recorded at Brain Symposium in March 2023, Toby Jeffcote initially takes us through all the sedatives currently used in brain injury and the evidence to support their use. He then covers the history of ketamine use and the background to new research in use as a therapeutic agent.
Summary
Potential benefits of ketamine include:
- Sedative and analgesic sparing
- Alternative mechanism of action to GABA agonists
- Cardiovascular stability from infusion and bolus
- Potential for amelioration of excitotoxic secondary brain injury
One mechanism by which Ketamine may be beneficial is by reducing cortical spreading depolarisation (CSD) and ischaemia. For more on this, do listen to Toby’s talk on CSD here.
Cortical Spreading Ischaemia from Oliver Flower on Vimeo.
To answer the commonest concerns, Toby discusses ketamine’s effect on ICP, how safe it is and whether it increases delirium in ICU patients, all setting the scene for the pilot trial that is currently ongoing.
Slides
