gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Sedation of patients with acute aneurysmal subarachnoid haemorrhage with Ketamine is safe and might influence the occurrence of delayed cerebral ischemia

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  • Christian von der Brelie - Neurochirurgische Klinik, Universitätsklinik Schleswig-Holstein, Campus Kiel, Neurochirurgische Universitätsklinik Göttingen, Göttingen, Deutschland
  • Michael Seifert - Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin Unfallkrankenhaus Berlin, Berlin, Deutschland
  • Sergej Rot - Klinik für Neurochirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland
  • Anja Tittel - Klinik für Radiologie und Neuroradiologie Unfallkrankehaus Berlin, Berlin, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Ullrich Meier - Unfallkrankenhaus Berlin, Neurochirurgische Klinik, Berlin, Deutschland
  • Johannes Lemcke - Unfallkrankenhaus Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.19.02

doi: 10.3205/17dgnc493, urn:nbn:de:0183-17dgnc4930

Published: June 9, 2017

© 2017 von der Brelie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: 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 should assess the influence of Ketamine on the ICP, on the consumption of vasopressors in induced hypertension therapy as well as on the occurrence of DCI associated cerebral infarctions with particular focus on the complications of sedation in patients with aneurysmal subarachnoid haemorrhage (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 (RASS score, ICP values, consumption of vasopressors, complications of sedation, outcome and other clinical parameters) were analyzed. Cranial CT scan imaging results were analyzed.

Results: Forty-one patients underwent sedation including Ketamine (63.1%). Ketamine lowered the ICP in 92.7% of the cases. Vasopressors could bereduced in 53.6%. DCI associated cerebral infarctions occurred significantly less often in the patient cohort being treated with sedation including Ketamine (7.3% versus 25% in the non - Ketamine group; p = 0.04). The rate of major complications was not higher in the Ketamine group. Outcome was not different regarding the groups either if they were sedated with or without Ketamine.

Conclusion: Ketamine lowers the intracranial pressure while it was not associated with a higher rate of complications. The rate of DCI associated cerebral infarctions was lower in the Ketamine group. Ketamine administration lead to a reduction of vasopressors used for induced hypertension.