EFFECTS OF LOW DOSES OF KETAMINE ON INTRACRANIAL PRESSURE IN PATIENTS HAVING SPACE OCCUPYING LESION OF THE BRAIN
Main Article Content
Keywords
Ketamine, Optic nerve sheath diameter, Intracranial pressure, Supratentorial tumour, Neuroanaesthesia
Abstract
Background
Expansion of intracranial contents by a space-occupying lesion (SOL) leads to compression and distortion of the tissues of the CNS and can increase intracranial pressure(ICP). It was presumed that ketamine can cause a dangerous increase in ICP by increasing blood pressure. The present study was conducted to investigate the effects of low doses of ketamine on ICP in patients having space occupying lesion of the brain.
Methods
The study was conducted on 45 patients after obtaining approval from ethical committee. Patients included were posted for elective supratentorial surgeries for brain tumour excision. Standard induction was done intravenously in all patients with propofol, fentanyl and vecuronium with 5ml of normal saline (Group A), 0.25mg/kg ketamine diluted to 5ml (Group B), 0.5mg/kg ketamine diluted to 5ml (Group C). Optic nerve sheath diameter(ONSD) measurement by ocular sonography which serves as an indirect non-invasive technique to measure ICP was recorded at 3 instances i.e. before start of IV boluses of drugs, at 2 mins of bag and mask ventilation and at 5 mins of post endotracheal intubation.
Result
ONSD values were comparable in all three groups at baseline. ONSD value decreased in all groups after 2 minutes of BMV and were comparable in all groups. Values slightly increased at 5 minutes after endotracheal intubation as compared to 2 minutes; though values were lesser than baseline in every group.
Conclusion
Our study refutes the old opinion that ketamine increases ICP. Combined with a benzodiazepine and barbiturates, ketamine may be the preferred sedative/anaesthetic agent for patients with space occupying lesion and can reduce ICP as well.
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Dr. Ravindra Sisodia
Assistant Professor and Director, Department of Neuro-anaesthesiology
Dr. Shubham Khandelwal
Assistant Professor, Department of Anaesthesiology and critical care
Dr. Nisha Sharma
Assistant Professor, Department of Neuro-anaesthesiology
Dr. Vijay Mathur
Professor and Head, Department of Neuro-anaesthesiology
Dr. Medha Bhardwaj
DM Resident , Department of Neuro-anaesthesiology
Dr. Sunita Sharma
Associate Professor, Department of Neuro-anaesthesiology
Dr. Aishwarya Bajaj
Senior Resident Department of Emergency Medicine JSSAHER, Mysore, Karnataka Contact:+919871125869