title: Sedation of Patients with Acute Aneurysmal Subarachnoid Hemorrhage with Ketamine Is Safe and Might Influence the Occurrence of Cerebral Infarctions Associated with Delayed Cerebral Ischemia.
abstract: BACKGROUND
  Ketamine has neuroprotective characteristics as well as beneficial cardiocirculatory properties and may thus reduce vasopressor consumption. In contrast, sedation with ketamine (like any other sedative drug) has side effects. This study assesses the influence of ketamine on intracranial pressure (ICP), on the consumption of vasopressors in induced hypertension therapy, and on the occurrence of delayed cerebral ischemia (DCI)-associated cerebral infarctions, with particular focus on the complications of sedation in patients with aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  This is a retrospective, observational study. Sixty-five patients with SAH who underwent a period of sedation were included. The clinical course variables (Richmond Agitation and Sedation scale score, ICP values, consumption of vasopressors, complications of sedation, outcome, and other clinical parameters) were analyzed. Cranial computed tomography results were analyzed.
  
  
  RESULTS
  Forty-one patients underwent sedation including ketamine (63.1%). Ketamine decreased the ICP in 92.7% of the cases. Vasopressors was reduced in 53.6%. DCI-associated cerebral infarctions occurred significantly less often in the patient cohort being treated with sedation including ketamine (7.3% vs. 25% in the nonketamine group; P = 0.04). The rate of major complications was not higher in the ketamine group. Outcome was not different regarding the groups if they were sedated with or without ketamine.
  
  
  CONCLUSIONS
  Ketamine decreases the ICP and is not associated with a higher rate of complications. The rate of DCI-associated cerebral infarctions was lower in the ketamine group. Ketamine administration led to a reduction of vasopressors used for induced hypertension.
authors.affiliation: Department of Neurosurgery, University of Göttingen, Göttingen, Germany; Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany. Electronic address: cvdb@gmx.net.
authors.forename: Christian
authors.initials: C
authors.lastname: Von der Brelie
authors.affiliation: Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Seifert
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Sergej
authors.initials: S
authors.lastname: Rot
authors.affiliation: Department of Radiology, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Tittel
authors.affiliation: Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Sanft
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Meier
authors.affiliation: Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Lemcke
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics; D002544:Cerebral Infarction / Q000401:mortality* / Q000517:prevention & control*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Cerebral aneurysm; Delayed cerebral ischemia; Intracranial pressure; Ketamine; Subarachnoid hemorrhage