Ketamine + increase of ICP

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Ivan,

I applaud your German!
> 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).
The text deals with patients under respiratory control. As I have
written before, it is crucial to avoid hypoxia. Once you decide to use
midazolam, propofol or the like that is exactly what you get - hypoxia.
Thus the need for intubation and ventilation.
Now if you deal with an - say: entrapped - patient in a car it may make
very much sense to administer small doses of ketamin and withhold
midazolam to avoid exactly this situation. Once the patient is
extricated and fully accessible you can proceed as you want.

Cheers!

Mathias

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