Adverse cardiovascular effects of ketamine infusion in patients with catecholamine-dependent heart failure.
The longterm effects of ketamine on haemodynamic parameters and exogenous catecholamine requirements were studied in twenty-five critically ill patients with catecholamine-dependent heart failure. Following sedation with midazolam (0.15 +/- 0.07, mg.kg-1.h-1) and sufentanil (0.88 +/- 0.33 microgram.kg-1.h-1), patients with impaired left ventricular function (left ventricular ejection fraction area 30 +/- 7%) were randomly assigned to receive ketamine (2.5 +/- 0.9 mg.kg-1.h-1) and midazolam (Group A) or remained on sufentanil/midazolam (Group B). Haemodynamic measurements were performed throughout the first 24 hours after randomization. In group A cardiac index decreased by 21% (P = 0.01), mean arterial pressure increased by 13% (P = 0.01), mean pulmonary artery pressure by 14% (P = 0.04), pulmonary capillary wedge pressure by 20% (P = 0.03), and systemic vascular resistance index by 38% (P < 0.001). No significant cardiovascular effects were observed in Group B. Neither group had significant changes of exogenous catecholamine requirement. In conclusion, ketamine exhibits potential negative cardiovascular effects in patients with catecholamine-dependent heart failure. Therefore, ketamine should not be considered a first line drug for longterm sedation of patients with impaired left ventricular function.
Christ
G
G
Department of Cardiology, University of Vienna, Austria.
Mundigler
G
G
Merhaut
C
C
Zehetgruber
M
M
Kratochwill
C
C
Heinz
G
G
Siostrzonek
P
P
D000368:Aged; D000778:Anesthetics, Dissociative / Q000009:adverse effects* / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D002395:Catecholamines / Q000627:therapeutic use*; D003422:Critical Care; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007262:Infusions, Intravenous; D007649:Ketamine / Q000009:adverse effects*; D008297:Male; D008874:Midazolam / Q000494:pharmacology; D008875:Middle Aged; D012121:Respiration, Artificial; D017409:Sufentanil / Q000494:pharmacology*
D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D006993:Hypnotics and Sedatives; D007649:Ketamine; D017409:Sufentanil; D008874:Midazolam