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LETTER TO EDITOR
Year : 2020  |  Volume : 4  |  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


Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital, Bali, Indonesia

Date of Submission21-Apr-2020
Date of Decision15-May-2020
Date of Acceptance22-May-2020
Date of Web Publication18-Jul-2020

Correspondence Address:
Dr. Roy Lizal
JL SMA 3 No. 17, Denpasar, Bali 80235
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/BJOA.BJOA_56_20

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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



Sir,

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).[1],[2],[3] The effect of the combination of propofol and ketamine on cerebral circulation has not been fully investigated.[4]

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.[5] Ketamine has been shown to decrease CBF and does not to affect on ICP in anesthetized humans.[6]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kock M, Loix S, Lavand'homme P. Ketamine and peripheral inflammation. CNS Neurosci Ther 2013;19:403-10.  Back to cited text no. 1
    
2.
Demoina IG, Wiryana M, Suarjaya PP, Pradhana AP. Role of flow velocity and transient hyperemic response evaluated by transcranial doppler for assesing brain autoregulation in mild traumatic brain injury: A case report. Bali J Anesthesiol 2019;3:74-7.  Back to cited text no. 2
    
3.
Chandra S. Ketamine: Old drug, a new option. Bali J Anesthesiol 2019;3:137-9.  Back to cited text no. 3
    
4.
Dawson B, Michenfelder JD, Theye RA. Effects of ketamine on canine cerebral blood flow and metabolism: Modification by prior administration of thiopental. Anesth Analg 1971;50:443-7.  Back to cited text no. 4
    
5.
Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg 1995;81:84-9.  Back to cited text no. 5
    
6.
Parikh B, Maliwad J, Shah VR. Preventive analgesia: Effect of small dose of ketamine on morphine requirement after renal surgery. J Anaesthesiol Clin Pharmacol 2011;27:485-90.  Back to cited text no. 6
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