From the Guidelines
Ketamine can be safely administered to patients with suspected or confirmed head injuries and those in hypertensive emergency, with careful consideration of its potential effects on blood pressure and intracranial pressure, as supported by recent studies and guidelines 1.
Key Considerations for Ketamine Administration
- In patients with suspected or confirmed head injuries, ketamine can be used for rapid sequence intubation and procedural sedation at standard doses of 1-2 mg/kg IV, with careful monitoring of hemodynamics and oxygenation.
- For hypertensive emergencies, ketamine should be used cautiously due to its potential to transiently increase blood pressure, although this effect is often minimal at lower doses (0.1-0.5 mg/kg).
- The benefits of ketamine for pain control and reduced opioid requirements may outweigh potential transient blood pressure effects when used judiciously in hypertensive patients.
Alternative Agents for Hypertensive Emergencies
- According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, alternative agents for hypertensive emergencies include:
Clinical Practice and Guidelines
- Current guidelines support the use of ketamine in traumatic brain injury patients, particularly for rapid sequence intubation and procedural sedation 1.
- Clinicians should maintain appropriate hemodynamic monitoring, ensure adequate oxygenation, and consider using ketamine as part of a balanced approach with other agents when necessary.
- The shift in practice stems from improved understanding of ketamine's physiological effects, showing it can maintain cerebral perfusion pressure while providing effective analgesia and sedation without significant adverse outcomes in most neurologically injured patients 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Administration of Ketamine in Patients with Suspected/Confirmed Head Injury
- The use of ketamine in patients with acute brain injury has been debated due to its possible effects on cerebral circulation and perfusion 2, 3.
- Recent studies suggest that ketamine may not increase intracranial pressure and may even be beneficial in patients with traumatic brain injury 2, 3, 4.
- A systematic review of 11 studies found no evidence of harm during ketamine use in patients with acute brain injury, and some studies reported a decrease in intracranial pressure following ketamine administration 2.
- Another study found that ketamine did not increase intracranial pressure in severe TBI patients and may even lower it in selected cases 4.
Administration of Ketamine in Hypertensive Emergency
- There is limited evidence on the use of ketamine in hypertensive emergency, but it has been used as an anesthetic in patients with acute brain injury and hypertension 5.
- A study comparing ketamine and sufentanil for sedation in severe head injury patients found no significant differences in intracranial pressure and cerebral perfusion pressure between the two groups 5.
- However, the study found that heart rate values were significantly higher in the ketamine group, and more fluids were given on the first therapy day in the sufentanil group 5.
New Clinical Practice or Guidelines
- There is no clear consensus on the use of ketamine in patients with suspected/confirmed head injury or hypertensive emergency, and more research is needed to establish guidelines for its use 2, 3, 4, 5.
- A systematic review of procedural sedation in the emergency department found that low-dose ketamine combined with propofol may be associated with a shorter recovery time and fewer sedation events compared to opioids and propofol, but the evidence is limited and inconsistent 6.