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Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials

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Abstract

Background

Ketamine is traditionally avoided in sedation management of patients with risk of intracranial hypertension. However, results from many clinical trials contradict this concern. We critically analyzed the published data of the effects of ketamine on intracranial pressure (ICP) and other cerebral hemodynamics to determine whether ketamine was safe for patients with hemodynamic instability and brain injuries.

Methods

We systematically searched the online databases of PubMed, Medline, Embase, Current Controlled Trials, and Cochrane Central (last search performed on January 15, 2014). Trial characteristics and outcomes were independently extracted by two assessors (Xin Wang, Xibing Ding). For continuous data, mean differences (MD) were formulated. If the P value of the chi-square test was >0.10 or I 2 <50 %, a fixed-effects model was used; otherwise, the random effects model was adopted.

Results

Five trials (n = 198) met the inclusion criteria. Using ICP levels within the first 24 h of ketamine administration as the main outcome, the use of ketamine leads to the same ICP levels as opioids [MD = 1.94; 95 % confidence interval (95 % CI), −2.35, 6.23; P = 0.38]. There were no significant differences in mean arterial pressure values between the two groups (MD = 0.99; 95 % CI, −2.24, 4.22; P = 0.55). Ketamine administration was also comparable with opioids in the maintenance of cerebral perfusion pressure (MD = −1.07; 95 % CI, −7.95, 5.8; P = 0.76).

Conclusions

The results of this study suggest that ketamine does not increase ICP compared with opioids. Ketamine provides good maintenance of hemodynamic status. Clinical application of ketamine should not be discouraged on the basis of ICP-related concerns.

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Acknowledgments

We are grateful for the support from the National Natural Science Foundation. We also thank all authors of the publications included in this study for contributing information as requested.

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Authors and Affiliations

  1. Department of Anesthesiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang zhong Road, Shanghai, 200072, China

    Xin Wang, Xibing Ding, Yao Tong, Jiaying Zong, Xiang Zhao, Hao Ren & Quan Li

  2. First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, China

    Xin Wang & Jiaying Zong

  3. Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China

    Quan Li

Authors
  1. Xin Wang
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  2. Xibing Ding
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  3. Yao Tong
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  4. Jiaying Zong
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  5. Xiang Zhao
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  6. Hao Ren
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  7. Quan Li
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Corresponding author

Correspondence to Quan Li.

Additional information

X. Wang and X. Ding contributed equally to this work.

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Wang, X., Ding, X., Tong, Y. et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 28, 821–827 (2014). https://doi.org/10.1007/s00540-014-1845-3

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  • DOI: https://doi.org/10.1007/s00540-014-1845-3

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