|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 143-144
Low-dose ketamine with propofol sedation lowers the mean flow velocity of the middle cerebral artery measured by transcranial Doppler
Tjokorda Gde Agung Senapathi, I Putu Pramana Suarjaya, I Made Agus Kresna Sucandra, Roy Lizal
Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital, Bali, Indonesia
|Date of Submission||21-Apr-2020|
|Date of Decision||15-May-2020|
|Date of Acceptance||22-May-2020|
|Date of Web Publication||18-Jul-2020|
Dr. Roy Lizal
JL SMA 3 No. 17, Denpasar, Bali 80235
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agung Senapathi TG, Pramana Suarjaya I P, Kresna Sucandra I M, Lizal R. Low-dose ketamine with propofol sedation lowers the mean flow velocity of the middle cerebral artery measured by transcranial Doppler. Bali J Anaesthesiol 2020;4:143-4
|How to cite this URL:|
Agung Senapathi TG, Pramana Suarjaya I P, Kresna Sucandra I M, Lizal R. Low-dose ketamine with propofol sedation lowers the mean flow velocity of the middle cerebral artery measured by transcranial Doppler. Bali J Anaesthesiol [serial online] 2020 [cited 2020 Aug 6];4:143-4. Available from: http://www.bjoaonline.com/text.asp?2020/4/3/143/290096
The combination of propofol and ketamine is recommended for total intravenous anesthesia because the opposing effects of an individual anesthetic drug result in intraoperative hemodynamic stability. There is some controversy concerning the effects of ketamine on cerebral circulation. Ketamine has been reported to increase cerebral blood flow (CBF) and intracranial pressure (ICP).,, The effect of the combination of propofol and ketamine on cerebral circulation has not been fully investigated.
Sedation is one of the major treatments of intracranial hypertension. Ketamine is an anesthetic drug that is well suited to hypovolemic or normovolemic patients because it stimulates the cardiovascular system and furthermore maintains hemodynamic status. Unfortunately, potential adverse effects of ketamine in neurosurgical anesthesia have been well established, and the drug is usually contraindicated in neurosurgical patients who have intracranial hypertension because of its reported effect on ICP and CBF. Ketamine has been shown to decrease CBF and does not to affect on ICP in anesthetized humans.
Transcranial Doppler (TCD) is a noninvasive ultrasound study used to measure CBF velocity in major intracranial arteries. We observed 12 nonneurosurgical cases recently who underwent surgery under general anesthesia. All patients were induced with propofol and the sedation was maintained with propofol continuous. Six from 12 patients were given ketamine subanesthetic dose (0.2–0.5 mg/kg) after the induction, and the other six were given placebo (saline). At the stated dose, ketamine provides satisfactory analgesia during surgery and the management of postsurgical pain, without any sedation or changes in hemodynamic and respiratory. Effects of nausea and vomiting are also much reduced at this dose. We observed by TCD that the mean flow velocity (MFV) in the ketamine group was lower than the placebo group. After extubation, we found no side effects of ketamine such as hallucination, hypersecretion, headache, and nausea. The pain score is also slightly higher in the placebo group.
The administration of low-dose ketamine in patients sedated with propofol may not increase MFV of the middle cerebral artery. Postoperatively, ketamine also provides good analgesia without any side effects. We believe that a study designed to clarify the effects of propofol with subanesthetic dose of ketamine on the MFV of the middle cerebral artery using TCD will be useful to gain more insights about this phenomenon.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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