title: The ketamine effect on intracranial pressure in nontraumatic neurological illness.
abstract: OBJECTIVE
  The purpose of the study was to perform a systematic review of the literature on the use of ketamine in nontraumatic neurological illness and its effects on intracranial pressure (ICP).
  
  
  METHODS
  Articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2014), and gray literature were searched. Two reviewers identified manuscripts on the administration of ketamine in nontraumatic neurological illness that recorded effects on ICP. The strength of evidence was adjudicated using the Oxford and Grading of Recommendation Assessment Development and Education (GRADE) methodology.
  
  
  RESULTS
  Our search produced a total of 179 citations. Sixteen articles, 15 manuscripts, and 1 meeting proceeding were included in the review. Across all studies, there were 127 adult and 87 pediatric patients described. Intracranial pressure did not increase in any of the adult studies reporting premedication during ketamine administration, with 2 studies reporting a decrease in ICP. No significant non-ICP-related adverse events from ketamine were recorded in any of the studies.
  
  
  CONCLUSIONS
  There exists Oxford level 2b, GRADE C evidence in adults and level 4, GRADE C in pediatrics to support that ketamine does not increase ICP in nontraumatic neurological illness when patients are sedated and ventilated, and in fact may lower it in selected cases.
authors.affiliation: Section of Neurosurgery, Dept of Surgery, University of Manitoba, Winnipeg, Canada; Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada. Electronic address: umzeiler@cc.umanitoba.ca.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Zeiler
authors.affiliation: Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Teitelbaum
authors.affiliation: Section of Neurosurgery, Dept of Surgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: West
authors.affiliation: Section of Critical Care Medicine, Dept of Medicine, University of Manitoba, Winnipeg, Canada; Section of General Surgery, Dept of Surgery, University of Manitoba, Winnipeg, Canada.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Gillman
mesh_terms: D000328:Adult; D000778:Anesthetics, Dissociative / Q000494:pharmacology*; D001927:Brain Diseases; D002648:Child; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects*; D007649:Ketamine / Q000494:pharmacology*; D008297:Male
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine
keywords: ICP; Intracranial pressure; Ketamine; Neurological illness