Ketamine vs. Etomidate in head trauma with low BP

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Mathias & all interested...I love this conversation, extremely stimulating, let's just not overheat it please.
 
I understand Ketamine has been used for many yrs in many countries and is great to use in the field, especially as it is cheap and I guess it also is a wonderful anesthetic for animals. One of the reasons for that is that the patients reliably keep on breathing spontaneously and you don't need to bag them and you don't need a ventilator, ETT and all that.
 
However, the less obvious are the potential complications as they can hide behind the head injury that is there already:
 
1/ increase in ICP  (I guess at least controversial, a number of articles say it does, others say only sometimes).
 
2/ the wide individual variability also does not reliable assure whether the patient is just sedated/analgesic or in general anesthesia with the aspiration risk.
 
I feel that what most people are emotionally saying is that they like Ketamine and don't you talk badly about my drug.
It's probably still OK in non-head injured pts, of which we still have many (apart from tachycardia, salivation etc.).
 
(The issue of seizures is there of course with both Ketamine and Etomidate, and so Propofol or Thiopenthal if the BP is good is best actually in head-injured patients with stable BP).
 
If your mother suffers head trauma and her BP is low are you saying you'll intubate her with Ketamine instead of Etomidate followed by steroids ?? You are not going to tremble that she doesn't herniate on you ?? Really ??
 
Ivan, 
CA
 



> Date: Fri, 3 Aug 2007 17:59:58 +0200> From: listen at doc-kalkum.de> To: trauma-list at trauma.org> Subject: Re: Ketamine - disadvantages in trauma pts.> > Ivan e.a.,> > - snip - > > > > Ketamine increases cerebral metabolism, CBF, and ICP. Because of its excitatory CNS effects, which can be detected by generalized EEG development of theta-wave activity,[463] as well as by petit mal seizure-like activity in the hippocampus,[482] ketamine increases CMRO2.> - snip -> > the issue of whether ketamin is a suitable agent in the field for trauma> patients, especially in the group of those with head injuries, turns up> every year or two in this group. To make a long story short: the> "disadvantages of ketamin" in trauma are a remnant in barely actualised> textbooks. Outside of these the drug is used for decades in many> countries of the world, has (at least in small series and reports) been> proved to be as well safe and effective and is actually recommended as> safe in the treatment of skull / head / braintrauma. Thus it has made> it's way in the current guidelines at least in my country> (http://www.uni-duesseldorf.de/WWW/AWMF/ll/030-076.htm).> > Maybe we should add a small chapter on drugs in braintrauma to this> page: http://www.trauma.org/index.php/main/article/392/> > Cheers!> > Mathias> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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