The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries

CNS Neurosci Ther. 2013 Jun;19(6):390-5. doi: 10.1111/cns.12077. Epub 2013 Mar 11.


Traditionally, the use of ketamine for patients with traumatic brain injuries is contraindicated due to the concern of increasing intracranial pressure (ICP). These concerns, however, originated from early studies and case reports that were inadequately controlled and designed. Recently, the concern of using ketamine in these patients has been challenged by a number of published studies demonstrating that the use of ketamine was safe in these patients. This article reviews the current literature in regards to using ketamine in patients with traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine. Studies examining the use of ketamine for induction, maintenance, and sedation in patients with TBI have had promising results. The use of ketamine in a controlled ventilation setting and in combination with other sedative agents has demonstrated no increase in ICP. The role of ketamine as a neuroprotective agent in humans remains inconclusive and adequately powered; randomized controlled trials performed in patients undergoing surgery for traumatic brain injury are necessary.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anesthetics, Dissociative / therapeutic use*
  • Brain Injuries / complications
  • Brain Injuries / drug therapy*
  • Databases, Factual / statistics & numerical data
  • Emergency Service, Hospital*
  • Humans
  • Intracranial Hypertension / drug therapy
  • Intracranial Hypertension / etiology
  • Ketamine / therapeutic use*


  • Anesthetics, Dissociative
  • Ketamine