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Published on: January 20, 2023
Ketamine Use in Acute Brain Injury: Debunking the Myth
Steven Haywood1, Rylee Pence2, Vishnu Mudrakola3
1Department of Emergency Medicine, Emergency Medicine Residency, Magnolia Regional Health Center in Corinth, MS, USA.
Emergency Medicine Clinics of North America
|June 24, 2026
Summary
Ketamine may be safe for traumatic brain injury (TBI) patients, challenging the dogma of avoiding it due to fears of increased intracranial pressure (ICP). Recent studies show ketamine may even reduce ICP and improve brain blood flow.
Area of Science:
- Neuroscience
- Anesthesiology
- Trauma Care
Background:
- Historically, ketamine use in traumatic brain injury (TBI) patients was contraindicated due to concerns about elevated intracranial pressure (ICP).
- This long-standing recommendation was not supported by clinical data specific to TBI patients.
- Emerging evidence suggests ketamine possesses neuroprotective qualities potentially beneficial for TBI management.
Purpose of the Study:
- To re-evaluate the safety and efficacy of ketamine in patients with traumatic brain injury.
- To investigate the actual effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in TBI patients.
- To challenge the existing dogma regarding ketamine contraindication in TBI.
Main Methods:
- Review of contemporary, well-controlled studies investigating ketamine administration in TBI patients.
- Analysis of data concerning ICP and CPP changes following ketamine use in this population.
- Comparison of findings with historical recommendations and underlying assumptions.
Main Results:
- Ketamine administration did not result in a significant increase in ICP in TBI patients in recent controlled studies.
- Evidence suggests ketamine may actually decrease ICP in TBI patients.
- Ketamine use was associated with an increase in cerebral perfusion pressure (CPP) in TBI patients.
Conclusions:
- The contraindication of ketamine in TBI patients based on ICP concerns is not supported by current evidence.
- Ketamine may be a safe and potentially beneficial anesthetic agent for patients with TBI.
- Further research should explore the neuroprotective benefits and optimal use of ketamine in TBI management.
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