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Sat Aug 4 17:52:07 BST 2007

Die Applikation von Ketamin führt in Kombination mit Propofol oder einem Benzodiazepin beim kontrolliert beatmeten Patienten nicht zum ICP-Anstieg. Daher ist die Verabreichung von Ketamin nach aktueller Datenlage insbesondere beim hämodynamisch instabilen, beatmeten SHT-Patienten zulässig. Mathias - even in your German guidelines you are told to combine Ketamine with benzos or Propofol - and the increase in ICP is disproven only in pts. on controlled ventilation, which in the initial care of the trauma patients is not the case (it comes from a study on ventilated ICU patients only).Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020

> 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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Ketamine + increase of ICP