Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies
- 1 October 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Neurosurgical Anesthesiology
- Vol. 19 (4), 257-262
- https://doi.org/10.1097/ana.0b013e31811f3feb
Abstract
In neurosurgical patients, opioids are administered to prevent secondary cerebral damage. Complications often related to the administration of opioids are a decrease in blood pressure affording the use of vasopressors and intestinal atonia. One alternative approach to opioids is the application of S(+)-ketamine. However, owing to a suspected elevation of intracranial pressure (ICP), the administration of S(+)-ketamine has questioned for a long time. The aim of the present study was to evaluate ICP, gastrointestinal motility, and catecholamine consumption in neurosurgical patients undergoing 2 different protocols of anesthesia using fentanyl or S(+)-ketamine. Twenty-four patients sustaining traumatic brain injury or aneurysmal subarachnoid hemorrhage received methohexitone plus either fentanyl or S(+)-ketamine to establish a comparable level of sedation. To reach an adequate cerebral perfusion pressure (CPP), the norepinephrine dosage was adapted successively. Enteral nutrition and gastrointestinal stimulation were started directly after admission on the critical care unit. ICP, CPP, and norepinephrine dosage were recorded over 5 days and also the time intervals to full enteral nutrition and first defecation. There was no difference regarding ICP, CPP, and the time period until full enteral nutrition or first defecation between both groups. Patients who underwent analgesia with S(+)-ketamine showed a trend to a lower demand of norepinephrine compared with the fentanyl group. Our results indicate that S(+)-ketamine does not increase ICP and that its use in neurosurgical patients should not be discouraged on the basis of ICP-related concerns.Keywords
This publication has 43 references indexed in Scilit:
- Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhageJournal of Neurosurgery, 2006
- Analgosedierung mit (S)-Ketamin/Propofol vs. (S)-Ketamin/Midazolam: Steuerbarkeit, Stressreaktion und Hämodynamik - Eine kontrollierte Anwendungsbeobachtung bei operativen IntensivpatientenAINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, 2001
- Critical Pathway for the Treatment of Established Intracranial HypertensionJournal of Neurotrauma, 2000
- Ketamine for analgosedative therapy in intensive care treatment of head-injured patientsActa Neurochirurgica, 1996
- Gastric emptying following brain injury: Effects of choice of sedation and intracranial pressureIntensive Care Medicine, 1995
- Therapeutic time window and dose response of the beneficial effects of ketamine in experimental head injury.Stroke, 1994
- Epidural Anesthesia and AnticoagulationAnesthesiology, 1993
- Periorbital Edema After Atracurium AdministrationAnesthesiology, 1987
- The effect of ketamine on intracranial pressure during haemorrhagic shock under the conditions of both spontaneous breathing and controlled ventilationActa Neurochirurgica, 1985
- ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical ScaleThe Lancet, 1975