Advanced

Racemic, S(+)- and R(-)-ketamine do not increase elevated intracranial pressure

Schmidt, Anders LU ; Øye, I. and Åkeson, Jonas LU (2008) In Acta Anaesthesiologica Scandinavica 52(8). p.1124-1130
Abstract
Background: There is controversy regarding the influence of ketamine and its enantiomers on cerebral haemodynamics at increased intracranial pressure (ICP). This study was designed to compare cerebrovascular responses, with particular respect to ICP, to bolus injections of racemic, S(+)- and R(-)-ketamine in an experimental model of intracranial hypertension. Methods: Nine pigs were anaesthetised with fentanyl and vecuronium during mechanical normoventilation. The ICP was raised with extradural balloon catheters to 23 mmHg. The intra-arterial xenon clearance technique was used to determine cerebral blood flow (CBF). Three 60-s bolus injections of racemic ketamine (10 mg/kg), S-ketamine (5 mg/kg) and R-ketamine (20 mg/kg) were given in a... (More)
Background: There is controversy regarding the influence of ketamine and its enantiomers on cerebral haemodynamics at increased intracranial pressure (ICP). This study was designed to compare cerebrovascular responses, with particular respect to ICP, to bolus injections of racemic, S(+)- and R(-)-ketamine in an experimental model of intracranial hypertension. Methods: Nine pigs were anaesthetised with fentanyl and vecuronium during mechanical normoventilation. The ICP was raised with extradural balloon catheters to 23 mmHg. The intra-arterial xenon clearance technique was used to determine cerebral blood flow (CBF). Three 60-s bolus injections of racemic ketamine (10 mg/kg), S-ketamine (5 mg/kg) and R-ketamine (20 mg/kg) were given in a randomised sequence. Cerebral and systemic haemodynamic responses were evaluated before and at 1, 5, 10, 15, 30 and 45 min after each injection. Results: Racemic ketamine decreased ICP (P = 0.026) by maximally 10.8%, whereas there was no effect on ICP of S- (P = 0.178) or R-ketamine (P = 0.15). All study drugs had similar biphasic effects on CBF, with maximal initial decreases by 25-29%, followed by transient increases by 7-15%, and a reduction of mean arterial pressure by maximally 22-37%. Conclusions: A decrease or a lack of an increase in ICP in response to intravenous bolus injections of racemic, S- or R-ketamine suggests that the administration of racemic or S-ketamine might be safe in patients with intracranial hypertension due to a space-occupying lesion. The ICP-lowering effect indicates that racemic ketamine might offer a therapeutic advantage over S-ketamine. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
xenon, porcine, S-ketamine, racemic, ketamine, intracranial pressure, enantiomers, cerebral blood flow, anaesthesia, intravenous, R-ketamine
in
Acta Anaesthesiologica Scandinavica
volume
52
issue
8
pages
1124 - 1130
publisher
Wiley-Blackwell
external identifiers
  • wos:000258593200014
  • scopus:49849099656
ISSN
0001-5172
DOI
10.1111/j.1399-6576.2008.01698.x
language
English
LU publication?
yes
id
29f03932-aa66-4f37-95ed-a5614c0bb226 (old id 1252071)
date added to LUP
2008-11-03 16:08:50
date last changed
2017-07-02 03:35:48
@article{29f03932-aa66-4f37-95ed-a5614c0bb226,
  abstract     = {Background: There is controversy regarding the influence of ketamine and its enantiomers on cerebral haemodynamics at increased intracranial pressure (ICP). This study was designed to compare cerebrovascular responses, with particular respect to ICP, to bolus injections of racemic, S(+)- and R(-)-ketamine in an experimental model of intracranial hypertension. Methods: Nine pigs were anaesthetised with fentanyl and vecuronium during mechanical normoventilation. The ICP was raised with extradural balloon catheters to 23 mmHg. The intra-arterial xenon clearance technique was used to determine cerebral blood flow (CBF). Three 60-s bolus injections of racemic ketamine (10 mg/kg), S-ketamine (5 mg/kg) and R-ketamine (20 mg/kg) were given in a randomised sequence. Cerebral and systemic haemodynamic responses were evaluated before and at 1, 5, 10, 15, 30 and 45 min after each injection. Results: Racemic ketamine decreased ICP (P = 0.026) by maximally 10.8%, whereas there was no effect on ICP of S- (P = 0.178) or R-ketamine (P = 0.15). All study drugs had similar biphasic effects on CBF, with maximal initial decreases by 25-29%, followed by transient increases by 7-15%, and a reduction of mean arterial pressure by maximally 22-37%. Conclusions: A decrease or a lack of an increase in ICP in response to intravenous bolus injections of racemic, S- or R-ketamine suggests that the administration of racemic or S-ketamine might be safe in patients with intracranial hypertension due to a space-occupying lesion. The ICP-lowering effect indicates that racemic ketamine might offer a therapeutic advantage over S-ketamine.},
  author       = {Schmidt, Anders and Øye, I. and Åkeson, Jonas},
  issn         = {0001-5172},
  keyword      = {xenon,porcine,S-ketamine,racemic,ketamine,intracranial pressure,enantiomers,cerebral blood flow,anaesthesia,intravenous,R-ketamine},
  language     = {eng},
  number       = {8},
  pages        = {1124--1130},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Racemic, S(+)- and R(-)-ketamine do not increase elevated intracranial pressure},
  url          = {http://dx.doi.org/10.1111/j.1399-6576.2008.01698.x},
  volume       = {52},
  year         = {2008},
}