Effects of Ketamine Compared with Propofol on Multimodal Neuromonitoring and Clinical Outcomes in Moderate and Severe Traumatic Brain Injury: A Scoping Review
DOI:
https://doi.org/10.71112/h0gx2e12Keywords:
Traumatic brain injury, Ketamine, Propofol, Neuromonitoring, Intracranial pressure, NeuroanesthesiaAbstract
Background:
Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide and represents a significant challenge in the management of critically ill patients. The choice of anesthetic agent during induction and sedation may influence key physiological parameters such as intracranial pressure, cerebral perfusion pressure, and hemodynamic stability. Propofol has traditionally been widely used in neuroanesthesia due to its ability to reduce cerebral metabolic demand. However, ketamine has historically been avoided in patients with TBI because of the belief that it could increase intracranial pressure. Recent evidence has challenged this assumption, suggesting that ketamine may be safe and could even offer hemodynamic advantages in these patients.
Objective:
To explore and synthesize the available evidence regarding the effects of ketamine compared with propofol on multimodal neuromonitoring parameters and clinical outcomes in patients with moderate and severe traumatic brain injury.
Methods:
A scoping review was conducted following the PRISMA-ScR guidelines. A systematic search was performed in electronic databases including PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. The search strategy included terms related to traumatic brain injury, ketamine, propofol, intracranial pressure, and hemodynamic stability. After screening titles, abstracts, and full texts, twenty studies meeting the eligibility criteria were included. Data were extracted regarding study characteristics, multimodal neuromonitoring parameters, and clinical outcomes.
Results:
The included studies indicated that ketamine is not associated with clinically significant increases in intracranial pressure in adequately ventilated patients with TBI. Several studies reported greater hemodynamic stability and a lower incidence of post-induction hypotension with ketamine compared with propofol. Regarding multimodal neuromonitoring, most studies evaluated intracranial pressure and cerebral perfusion pressure. Clinical outcomes were heterogeneous across studies and did not consistently demonstrate significant differences between the two anesthetic agents.
Conclusions:
Current evidence suggests that ketamine can be safely used in patients with moderate and severe traumatic brain injury without increasing intracranial pressure, and its hemodynamic profile may represent an advantage over propofol in certain clinical scenarios. Nevertheless, further prospective studies and randomized controlled trials are needed to better define the impact of these anesthetic agents on long-term neurological and clinical outcomes.
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