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Discussion 1: Management of pain in the neonate

Journal of Perinatology volume 27, pages S19–S20 (2007)Cite this article

Q: One of the side effects of ketamine is its potential to increase intracranial pressure, especially in patients with brain trauma. Can this side effect be a concern for the neonatal patient population?

A: Dr Anand: I agree with the statement that ketamine administration may lead to increases in intracranial pressure and, if I may add, ketamine also increases heart rate and blood pressure. However, the increase in the intracranial pressure primarily occurs in patients with conditions associated with increased baseline intracranial pressure. I have used ketamine in patients presenting with traumatic brain injury but normal intracranial pressures and I have not observed any change in intracranial pressure under these circumstances. This situation is similar to what has been observed in patients with pulmonary hypertension, where ketamine may cause a further increase in pulmonary vascular resistance in patients with pre-existing pulmonary hypertension. Yet, in patients who have normal pulmonary vascular resistance, ketamine administration does not appear to lead to changes in the pulmonary vascular resistance. Ketamine's effect on pulmonary vascular resistance may result, at least in part, from the drug-induced release of endogenous catecholamines. There are a few conditions in the neonate potentially associated with increased intracranial pressure, such as meningitis or severe intraventricular hemorrhage. In neonates with these conditions, the use of ketamine should be avoided.

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References

  1. Bergman I, Steeves M, Burckart G, Thompson A . Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. J Pediatr 1991; 119: 644–649.

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Drs Anand, and Westrup

Moderated and edited by: Dr Seri

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Discussion 1: Management of pain in the neonate. J Perinatol 27 (Suppl 1), S19–S20 (2007). https://doi.org/10.1038/sj.jp.7211720

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