The Use of Ketamine in Trauma Patients

Abstract

Trauma is one of the leading causes of death worldwide. Stress response secondary to injury occurs at these patients. Because of pain respiratory rate can increase at them. In this regards airway management and hemodynamic stability are important parameters in trauma patients. Ketamine has noncompetitive antagonistic properties on the receptor of N-methyl-D aspartate (NMDA) and it can stimulate brainstem by noradrenalin reuptake inhibition. For that it can be used on monitorization of hemodynamic unstable trauma patients which monitorization is not suitable. We aimed to investigate the frequency of ketamine use in clinical practice in trauma patients and whether it is the preferred agent in traumatic brain injuries and injuries with increased intraocular pressure (IOB) by reviewing the literature.

Keywords

• Trauma,ketamine,analgesia,intracranial pressure,intraocular pressure

Travma Hastalarında Ketamin Kullanımı

Öz

Travma, dünya çapında ölümlerin önde gelen nedenlerinden biridir. Travma hastalarında meydana gelen akut ağrıya sekonder solunum zorluğu, yaralanmaya sekonder stres cevabı oluşabilir. Bu bakımdan travma hastalarında hava yolu yönetimi ve hemodinamik stabilite önemlidir. Ketamin, N-metil-D aspartate (NMDA) reseptörleri üzerinde nonkompetatif antagonistik özelliği ve beyin sapı uyarısı ile nöradrenalin reuptake inhibisyonu sağlar. Bu özelliği ile sempatik etki oluşturarak hemodinamik unstabil travma hastalarında ve monitorizasyonu sağlamanın uygun olmadığı şartlarda (Hastane öncesi afet, savaş yaralanmaları vb.) kullanımı açısından öncelikli ajan olarak literatürde sıkça vurgulanmaktadır. Travma hastalarında klinik pratikte ketaminin yeri, kullanım sıklığı, mortaliteyle doğrudan ilişkili Travmatik Beyin Yaralanmalarında (TBY) ve intraokuler basınç (IOB) artışı ile giden yaralanmalarda geçmişten günümüze tercih edilen ajan haline gelmesini literatür taraması ile aydınlatmayı amaçladık.

Anahtar Kelimeler

• Travma,ketamin,analjezi,intrakranial basınç,intraoküler basınç

References

1. Wedmore IS, Butler Jr FK. Battlefield analgesia in tactical combat casualty care. Wilderness & environmental medicine, 2017;28(2):109-16.
2. American College of Surgeons. ATLS: Advanced Trauma Life Support for Doctors (Student Course Manual). 9th ed. Chicago, IL:American College of Surgeons; 2012.
3. Baekgaard JS, Eskesen TG, Sillesen M, Rasmussen LS, Steinmetz J. Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review. Anesthesia & Analgesia, 2019;128(3):504-10.
4. Zietlow J, Berns K, Jenkins D, Zietlow S. Prehospital Use of Ketamine: Effectiveness in Critically Ill and Injured Patients. Military medicine, 2019;184(1):542-44.
5. Naughton M, Clarke G, Olivia FO, Cryan JF, Dinan TG. A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. Journal of affective disorders, 2014;156:24-35.
6. Best W, Bodenschatz C, Beran D. World Health Organisation Critical Review of Ketamine. 36th WHO Expert Committee on Drug Dependence report, 6.2. Geneva, Switzerland: World Health Organisation. 2014.
7. Luft AN, Mendes FF. Low S (+) ketamine doses: a review. Rev. Bras. Anestesiol. 2005;55 (4):460-9.
8. Davis, K. Ketamine: Ideal Pain Management for Traumatic Patients at High-Altitude. J Pain Manage Med, 2017;3(2):124.

9. Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The physiologically difficult airway. West J Emerg Med. 2015;16(7):1109-17.
10. Bowers KJ, McAllister KB, Ray M, Heitz C. Ketamine as an adjunct to opioids for acute pain in the emergency department: a randomized controlled trial. Acad Emerg Med. 2017;24(6):676-85.
11. Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The physiologically difficult airway. West J Emerg Med. 2015;16(7):1109-17.
12. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Annals of emergency medicine, 2011;57(5):449-61.
13. Krauss B, Green SM. Sedation and analgesia for procedures in children. New England Journal of Medicine, 2000;342(13):938-45.
14. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: part 2, review and implications. Annals of emergency medicine, 1990;19(9):1033-46.
15. Heinz P, Geelhoed GC, Wee C, Pascoe EM. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Emergency medicine journal, 2006; 23(3):206-9.
16. Bellolio MF, Puls HA, Anderson JL, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and metaanalysis. BMJ Open. 2016;6(6): e011384.
17. Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial. Annals of emergency medicine, 2012;59(6):504-12.
18. Häske D, Böttiger BW, Bouillon B, et al. Analgesia in Patients with Trauma in Emergency Medicine: A Systematic Review and Meta-analysis. Deutsches Ärzteblatt International, 2017;114(46):785.
19. Walters MK, Farhat J, Bischoff J, Foss M, Evans C. Ketamine as an analgesic adjuvant in adult trauma intensive care unit patients with rib fracture. Annals of Pharmacotherapy, 2018;52(9):849-54.
20. Bronsky ES, Koola C, Orlando A, et al. Intravenous Low-Dose Ketamine Provides Greater Pain Control Compared to Fentanyl in a Civilian Prehospital Trauma System: A Propensity Matched Analysis. Prehospital Emergency Care, 2019;23(1):1-8.
21. Wyte SR, Shapiro HM, Turner P, Harris AB. Ketamine-induced intracranial hypertension. Anesthesiology, 1972;36(2):174-6.
22. Shapiro HM, Wyte SR, Harris AB. Ketamine anaesthesia in patients with intracranial pathology. British Journal of Anaesthesia, 1972;44(11):1200-4.
23. Pfenninger E, Grünert A, Bowdler I, Kilian J. The effect of ketamine on intracranial pressure during haemorrhagic shock under the conditions of both spontaneous breathing and controlled ventilation. Acta neurochirurgica,1985;78(3-4):113-8.
24. Cohen L, Athaide V, Wickham ME, Doyle-Waters MM, Rose NG, Hohl CM. The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Annals of emergency medicine, 2015;65(1):43-51.
25. Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. Journal of Neurosurgery: Pediatrics, 2009;4(1):40-6.
26. Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. Neurocritical care, 2014;21(1):163-73.
27. Hill GJ, April MD, Maddry JK, Schauer SG. Prehospital ketamine administration to pediatric trauma patients with head injuries in combat theaters. The American journal of emergency medicine, 2018;37(8):1455-9.
28. Yoshikawa K, Murai Y. Effect of ketamine on intraocular pressure in children. Anesth Analg, 1971;50:199.
29. Halstead SM, Deakyne SJ, Bajaj L, Enzenauer R, Roosevelt GE. The effect of ketamine on intraocular pressure in pediatric patients during procedural sedation. Academic Emergency Medicine, 2012;19(10):1145-50.
30. Drayna PC, Estrada C, Wang W, Saville BR, Arnold DH. Ketamine is not associated with elevation of intraocular pressure during procedural sedation. The American journal of emergency medicine, 2012;30(7):1215.
31. Wahlen BM, El-Menyar A, Asim M, Al-Thani H. Rapid sequence induction (RSI) in trauma patients: Insights from healthcare providers. World journal of emergency medicine, 2019;10(1):19.
32. Ferguson I, Alkhouri H, Fogg T, Aneman A. Ketamine use for rapid sequence intubation in Australian and New Zealand emergency departments from 2010 to 2015: A registry study. Emergency Medicine Australasia, 2019;31(2):205-10.
33. Butler FK, Kotwal RS, Buckenmaier III CC, et al. A triple-option analgesia plan for tactical combat casualty care: TCCC guidelines change 13-04. J Spec Oper Med, 2014;14(1):13-25.
34. Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Regional Anesthesia & Pain Medicine, 2018;43(5):456-66.