Efectos de la ketamina frente al propofol en el neuromonitoreo multimodal y los desenlaces clínicos del traumatismo craneoencefálico moderado y grave: una Scoping Review
DOI:
https://doi.org/10.71112/h0gx2e12Palavras-chave:
Traumatismo craneoencefálico, Ketamina, Propofol, Neuromonitoreo, Presión intracraneal, Neuroanestesia.Resumo
Introducción:
El traumatismo craneoencefálico (TCE) constituye una de las principales causas de morbimortalidad a nivel mundial y representa un desafío importante en el manejo de pacientes críticos. La elección del agente anestésico durante la inducción y la sedación puede influir en parámetros fisiológicos clave como la presión intracraneal, la presión de perfusión cerebral y la estabilidad hemodinámica. Tradicionalmente, el propofol ha sido ampliamente utilizado en neuroanestesia debido a su capacidad para reducir el metabolismo cerebral. Sin embargo, la ketamina ha sido históricamente evitada en pacientes con TCE por la creencia de que podría aumentar la presión intracraneal. La evidencia reciente ha cuestionado esta hipótesis, sugiriendo que la ketamina podría ser segura e incluso presentar ventajas hemodinámicas en estos pacientes.
Objetivo:
Explorar y sintetizar la evidencia disponible sobre los efectos de la ketamina en comparación con el propofol en el neuromonitoreo multimodal y los desenlaces clínicos en pacientes con traumatismo craneoencefálico moderado y grave.
Métodos:
Se realizó una scoping review siguiendo los lineamientos de la extensión PRISMA-ScR. Se efectuó una búsqueda sistemática en bases de datos electrónicas, incluyendo PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials y Google Scholar. La estrategia de búsqueda incluyó términos relacionados con traumatismo craneoencefálico, ketamina, propofol, presión intracraneal y estabilidad hemodinámica. Tras la evaluación de títulos, resúmenes y textos completos, se incluyeron veinte estudios que cumplían con los criterios de elegibilidad. Se extrajeron datos relacionados con las características de los estudios, parámetros de neuromonitoreo multimodal y desenlaces clínicos.
Resultados:
Los estudios incluidos mostraron que la ketamina no se asocia con incrementos clínicamente significativos en la presión intracraneal en pacientes con TCE adecuadamente ventilados. En varios estudios, la administración de ketamina se relacionó con una mayor estabilidad hemodinámica y una menor incidencia de hipotensión en comparación con el propofol. En cuanto al neuromonitoreo multimodal, la mayoría de los estudios evaluaron principalmente la presión intracraneal y la presión de perfusión cerebral. Los desenlaces clínicos reportados fueron heterogéneos y no demostraron diferencias consistentes entre ambos agentes anestésicos.
Conclusiones:
La evidencia disponible sugiere que la ketamina puede utilizarse de forma segura en pacientes con traumatismo craneoencefálico moderado y grave sin incrementar la presión intracraneal, y que su perfil hemodinámico podría representar una ventaja frente al propofol en determinados escenarios clínicos. No obstante, se requieren estudios prospectivos y ensayos clínicos controlados que permitan evaluar con mayor precisión el impacto de estos agentes anestésicos sobre los desenlaces neurológicos y clínicos a largo plazo.
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Copyright (c) 2026 Alejandro Sebastián Grandes Padilla, Sandra Del Rocio Morocho Imbacuan, José Francisco Miranda Bajaña, Diana Beatriz Aguirre Urrutia, Marilyn Denise Guevara Acurio (Autor/a)
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
