Ketamine in Modern Neuroanesthesia Practice

Purpose of Review Ketamine has a number of clinical uses and properties that suggest a role for the drug in neuroanestheisa practice. "Dogma" and "myths" persist with regard to its effects on cerebral hemodynamics and intracranial pressure which have limited its use in Neuroanesthesia and care of the critically ill brain-injured patient. This review aims to educate the clinician on the possible role of ketamine in modern neuroanesthesia practice. Recent Findings A number of systemic reviews support the use of ketamine in patients with acute brain injury and raised intracranial pressure (ICP). Pre-clinical work suggests that ketamine may have mechanisms of action compatible with neuroprotection including modifying glutamate excitatory-driven mechanisms of brain injury. There is emerging clinical evidence to suggest that ketamine may inhibit spreading depolarizations (SDs), a cortical electrical phenomenon associated with brain injury. Ketamine is no longer contraindicated in the care of the brain-injured patient, and its properties of potent analgesia, dissociative anesthesia, and minimal effects on both the hemodynamic and respiratory system are being utilized in the pre-hospital and emergency room setting. Good grade data on meaningful clinical outcomes is presently lacking to support the use of ketamine as a drug with neuroprotection properties but is an area of ongoing interest.