The ketamine effect on intracranial pressure in nontraumatic neurological illness

Purpose: The purpose of the study was to perform a systematic review of the literature on the use of ketamine in nontraumatic neurological illness and its effects on intracranial pressure (ICP). Materials and methods: Articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to January 2014), and gray literature were searched. Two reviewers identified manuscripts on the administration of ketamine in nontraumatic neurological illness that recorded effects on ICP. The strength of evidence was adjudicated using the Oxford and Grading of Recommendation Assessment Development and Education (GRADE) methodology. Results: Our search produced a total of 179 citations. Sixteen articles, 15 manuscripts, and 1 meeting proceeding were included in the review. Across all studies, there were 127 adult and 87 pediatric patients described. Intracranial pressure did not increase in any of the adult studies reporting premedication during ketamine administration, with 2 studies reporting a decrease in ICP. No significant non-ICP-related adverse events from ketamine were recorded in any of the studies. Conclusions: There exists Oxford level 2b, GRADE C evidence in adults and level 4, GRADE C in pediatrics to support that ketamine does not increase ICP in nontraumatic neurological illness when patients are sedated and ventilated, and in fact may lower it in selected cases. (C) 2014 Elsevier Inc. All rights reserved.