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Ketamine increases opening cerebrospinal pressure in children undergoing lumbar puncture

Yoram Ben Yehuda1, Nathan Watemberg

  • 1Pediatric Emergency Unit, Wolfson Medical Center, Holon 58100, Israel.

Journal of Child Neurology
|September 5, 2006
PubMed

Insights

Adding ketamine to midazolam for procedural sedation in children with suspected meningitis increases cerebrospinal fluid opening pressure during lumbar puncture. However, this did not lead to different clinical outcomes between groups.

Area of Science:

  • Pediatric Anesthesiology
  • Neurology
  • Infectious Diseases

Background:

  • Intravenous ketamine and midazolam are common for pediatric procedural sedation.
  • Ketamine use may elevate intracranial pressure.
  • Lumbar puncture is a key diagnostic tool for suspected meningitis.

Purpose of the Study:

  • To investigate if ketamine combined with midazolam increases cerebrospinal fluid (CSF) opening pressure during lumbar puncture in children with suspected aseptic meningitis.
  • To assess the impact of ketamine on CSF pressure in this pediatric population.

Main Methods:

  • A comparative study involving 39 children (6 months to 14 years) undergoing lumbar puncture.
  • Group A received intravenous midazolam plus ketamine; Group B received intravenous midazolam only.
  • Cerebrospinal fluid opening pressure was measured during lumbar puncture.

Main Results:

  • Mean CSF opening pressure was significantly higher in the ketamine group (24.4 cm H2O) compared to the midazolam-only group (20 cm H2O) (P = .011).
  • The median CSF opening pressure also showed a significant difference between groups.
  • No significant differences in clinical outcomes were observed between the two groups.

Conclusions:

  • Pre-procedural ketamine administration is associated with elevated CSF opening pressure in children with suspected aseptic meningitis undergoing lumbar puncture.
  • Despite increased CSF pressure, ketamine combined with midazolam did not result in adverse outcome differences.
  • Caution may be warranted when using ketamine in pediatric patients with suspected meningitis where intracranial pressure is a concern.

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