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Related Concept Videos

Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.

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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
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Published on: February 8, 2022

Racemic, S(+)- and R(-)-ketamine do not increase elevated intracranial pressure.

A Schmidt1, I Øye, J Akeson

  • 1Department of Anaesthesiology and Intensive Care Medicine, Lund University, Malmö University Hospital, Malmö, Sweden. anders.schmidt@skane.se

Acta Anaesthesiologica Scandinavica
|October 9, 2008
PubMed
Summary
This summary is machine-generated.

Racemic ketamine decreased intracranial pressure (ICP) in pigs, while its enantiomers did not. Racemic ketamine may be safer for patients with intracranial hypertension, offering a therapeutic advantage.

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Pharmacology

Background:

  • Controversy exists regarding ketamine and its enantiomers' effects on cerebral hemodynamics during increased intracranial pressure (ICP).
  • This study investigated cerebrovascular responses to ketamine enantiomers in a model of intracranial hypertension.

Purpose of the Study:

  • To compare the effects of racemic, S(+)-, and R(-)-ketamine on cerebral hemodynamics, specifically ICP.
  • To evaluate the safety and potential therapeutic advantages of ketamine enantiomers in intracranial hypertension.

Main Methods:

  • Nine pigs with induced intracranial hypertension (23 mmHg) were administered bolus injections of racemic ketamine (10 mg/kg), S-ketamine (5 mg/kg), and R-ketamine (20 mg/kg) in a randomized sequence.
  • Cerebral blood flow (CBF) was measured using the intra-arterial xenon clearance technique.
  • Cerebral and systemic hemodynamic responses were monitored before and up to 45 minutes after each injection.

Main Results:

  • Racemic ketamine significantly decreased ICP by up to 10.8% (P=0.026).
  • S-ketamine (P=0.178) and R-ketamine (P=0.15) showed no significant effect on ICP.
  • All ketamine forms caused transient biphasic changes in CBF and reduced mean arterial pressure by 22-37%.

Conclusions:

  • Intravenous racemic or S-ketamine may be safe for patients with intracranial hypertension due to space-occupying lesions.
  • The ICP-lowering effect of racemic ketamine suggests a potential therapeutic advantage over S-ketamine in managing intracranial hypertension.