Evaluation of ketamine as a co-sedation with midazolam and propofol in severe head trauma patients: a non-invasive assessment of cerebral hemodynamics using transcranial doppler ultra sonography

ABSTRACT

The current study investigates the effect of ketamine bolus injection 3 mg/kg every 6 hours for 48 hours in patients with severe head injury [GCS midazolam 0.1 mg/kg/hr [n=15] or propofol infusion 3 mg kg hr for 48 hours [n=15] and compared their effects on cerebral hemodynamics, HR and MAP to patients in control group [n=10] which received dehydrating measures according to protocol applied in neuro-intensive care unit. In control group, there is non significant changes in all parameters except fluctuation in MV in first 24 hour with significant decrease in ICP in 2nd 24 hours. In [Midazolam-Ketamine] group in first 24 hour, and [propofol-Ketamine] groups, non significant changes in HR. or MAP. MV increases in [propofol-Ketamine] at [20-25 mm] significantly compared to control group. CPP and PI increase significantly in [Midazolam-Ketamine] and [propofol-Ketamine] groups compared to control group [P<0.01]. ICP showed non-significant difference between groups compared to control group. In second 24 hours, non significant changes in all groups compared to FIR or MAP except in [propofol-Ketamine] at 5 mm. MV and CPP showed significant elevation and P1 decrease at [2 min]-compared to control group in [propofol-Ketamine] group. In [Midazolam-Ketamine] and [propofol-Ketamine] group ICP decreases significantly compared to control group. There was significant improvement at 8 days GCS and C.T score and C.T score index with improvement outcome. These results suggests that ketamin, with midazolam and propofol have protective effect on head trauma patients through decreasing P1 and increasing MV in first phase and maintaing CPP with decreasing ICP in second phase