gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Ketamine administration neuroprotective sedation for elevated intracranial pressure might lead to a high incidence of sclerosing cholangitis

Ketamingabe zur neuroprotektiven Sedierung zur Behandlung erhöhten intrakraniellen Drucks kann zu einer hohen Rate sklerosierender Cholangitiden führen

Meeting Abstract

  • presenting/speaker Christian von der Brelie - Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Joern Schaeper - Georg August Universität, Anästhesiologie, Göttingen, Deutschland
  • Laura Berger - Georg August Universität, Anästhesiologie, Göttingen, Deutschland
  • Harald Schwoerer - Georg August Universität, Gastroenterology, Göttingen, Deutschland
  • Volker Ellenrieder - Georg August Universität, Gastroenterology, Göttingen, Deutschland
  • Veit Rohde - Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Michael Quintel - Georg August Universität, Anästhesiologie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP214

doi: 10.3205/19dgnc549, urn:nbn:de:0183-19dgnc5490

Veröffentlicht: 8. Mai 2019

© 2019 von der Brelie et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Secondary sclerosing cholangitis (SC-CIP) might develop after longer periods of intensive care treatment. The development of casts in the intrahepatic bile ducts and pronounced cholestasis are pathognomonic for SC-CIP. In the further course liver cirrhosis with indication for liver transplantation may develop. The aim of this study was to analyze risk factors which are associated with SC – CIP.

Methods: A retrospective observational analysis (01/2010 to 11/2015) was done. Clinical variables were reviewed. The records of 239 patients who underwent neuroprotective sedation were screened. Inclusion criteria were cholestasis (: bilirubin ≥2.4 mg/dl and/or γGT ≥1000 U/l) and validation of diagnosis via ERCP/MRCP. Thirty patients fulfilled the criteria of SC-CIP.

Results: All patients were sedated for treatment of critically increased intracranial pressure, 70% were male. Rate of mechanical ventilation was 100%, all patients developed systemic inflammatory response syndrome (SIRS) or sepsis. 87% continuously received ketamine (≥3 mg x kg body weight-1 x h-1). There was a significant correlation between the beginning of cholestasis and days on mechanical ventilation (R=0.948) as well as the days on anti-infectives (R=0.793). Formerly postulated SC-CIP triggers (mean arterial pressure <65 mmHg, number of transfused erythrocyte concentrates, obesity, prolonged prone position, PEEP >10 mbar and high doses of catecholamines) could be ruled out for this cohort.

Conclusion: This is by far the largest report on patients undergoing neurointensive treatment developing SC-CIP. Sedation with high doses of ketamine appears to be a contributing factor to the development of SC-CIP. Clinicians should be highly aware of this observation and Ketamine use should be re-evaluated with regard to this relevant medical complication. SIRS/sepsis and a low oxygenation index have been confirmed as potential relevant factors.