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Fri Aug 3 00:15:05 BST 2007

Well...

Disadvantages of Ketamine:

1. tachycardia - many trauma pts. are tachycardic enough already

Not necessarily a disadvantage; the tachycardia is actually as a result of a
direct sympathomimetic action.

 2. negative inotropic effect (that gets uncovered if catecholamines are
depleted and there is an insufficient sympathetic response to the
stimulation by Ketamine). 

It is my understanding that catchecholamine release does not mediate this
action so I do not understand that. K MIMICS the action, not releases it.

3. seizures (like Etomidate) and increase brain tissue O2 consumption
(unlike Etomidate)- problem e.g. in head traumas etc. 

No clinical effect from these - they are theoretical. I have used ketamine
extensively in head trauma with no apparent ill effect. Anyone else seen
trouble?

4. increased secretions everywhere

Usually only a problem with under 3s and can be dealt with using
glycopyrrholate or atropine.

If used as analgesic unclear when transition to general anesthesia with
aspiration risks ..

The whole point about ketamine (found in the earliest studies by Dundee) is
that even at anaesthetic doses aspiration is really rare. Hence its huge
popularity in Africa for single operator LSCS.

If you don't use Midazolam the seizures are more likely, too...

<shrug> Ditto with alfentanil. If it happens deal with it. As it happens I
have never seen it, but I probably will tomorrow having said that! 

I agree though that it is good in all these other situations, just it cannot
be used in a number of situations where Etomidate can.. Ivan Hronek MDChief,
Critical Care & Trauma AnesthesiaSFMC Gas, Inc.Lynwood, CA

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Ketamine vs. Etomidate in trauma pts.