Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil.
OBJECTIVE
The aim of the study was to compare the safety concerning cerebral hemodynamics of ketamine and sufentanil used for sedation of severe head injury patients, both drugs being used in combination with midazolam.


METHODS
Prospective, randomized, double-blind study.


METHODS
Intensive care unit in a trauma center.


METHODS
Twenty-five patients with severe head injury.


METHODS
Twelve patients received sedation with a continuous infusion of ketamine-midazolam and 13 with a continuous infusion of sufentanil-midazolam. All patients were mechanically ventilated with moderate hyperventilation.


RESULTS
Prognostic indicators (age, Glasgow Coma Scale scores, computed tomography diagnosis, and Injury Severity Scale score) were similar in the two groups at study entry. Measurements were carried out during the first 4 days of sedation. The average infusion rates during this time were 82 +/- 25 micro x kg x min ketamine and 1.64 +/- 0.5 microg x kg x min midazolam in the ketamine group and 0.008 +/- 0.002 microg x kg x min sufentanil and 1.63 +/- 0.37 microg x kg x min midazolam in the sufentanil group. No significant differences were observed between the two groups in the mean daily values of intracranial pressure and cerebral perfusion pressure. The numbers of intracranial pressure elevations were similar in both groups. The requirements of neuromuscular blocking agents, propofol, and thiopental were similar. Heart rate values were significantly higher in the ketamine group on therapy days 3 and 4 ( <.05). With regard to arterial pressure control, more fluids were given on the first therapy day and there was a trend toward greater use of vasopressors in the sufentanil group. Sedative costs were similar in the two groups.


CONCLUSIONS
The results of this study suggest that ketamine in combination with midazolam is comparable with a combination of midazolam-sufentanil in maintaining intracranial pressure and cerebral perfusion pressure of severe head injury patients placed under controlled mechanical ventilation.
Bourgoin
Aurélie
A
Department of Anesthesiology, Marseille University Hospital System, France.
Albanèse
Jacques
J
Wereszczynski
Nicolas
N
Charbit
Martine
M
Vialet
Renaud
R
Martin
Claude
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000778:Anesthetics, Dissociative / Q000494:pharmacology / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000494:pharmacology / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000187:drug effects; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012449:Safety; D017409:Sufentanil / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D007649:Ketamine; D017409:Sufentanil; D008874:Midazolam