Faculty Advisor(s)

Elisha Coppens

Document Type

Capstone

Publication Date

Spring 2023

Rights

© 2023 the Author

Abstract

Ketamine is a widely used medication that can be administered for the delivery of anesthesia as well as analgesia while supporting hemodynamics. A commonly taught concept based on early research is that ketamine should not be administered to those with acute brain injuries. Early research had stated that ketamine can cause a dangerous increase in intracranial pressure (ICP) and thus a decrease in cerebral perfusion and oxygenation in those with traumatic brain injuries (TBI) (Takeshita et al., 1972). More recent research has shown that ketamine may be efficacious for patients with TBIs and can decrease ICP (Dengler et al., 2022). In comparison, the use of propofol for induction is a widely accepted and much more common practice for induction with the benefits of possibly avoiding a detrimental increase in ICP (Adembri et al., 2007). This literature review was conducted to identify the benefits and safety of cerebral hemodynamics with the use of ketamine versus propofol for induction in the adult population presenting for decompressive craniotomy. A literature review of confounding evidence has been conducted, including electronic bibliographic databases, relevant articles, and several anesthesia textbooks. In searching the databases the focus was on studies using ketamine and propofol with acute brain injuries and their effects on intracranial pressure in patients presenting for decompressive craniotomies. There are currently 31 research studies and systematic reviews included. Positive clinical outcomes, such as decreased ICP, hemodynamic control, and ideal pain control, were noted in many of the studies and within the literature. It appears that the use of ketamine does not increase ICP and may be just as efficacious as propofol for those presenting with TBI (Breindahl et al., 2021).

Comments

MSNA Capstone

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