Anaes Cases · Intravenous induction agents
Ketamine in the head-injured patient — the overturned contraindication
A focused short case on the overturned ketamine-in-TBI contraindication — the modern trials (BIKe, KETA-BID) showing no rise in ICP at induction doses, and ketamine's suitability for the shocked, head-injured patient.
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Prompt
A 35-year-old man with a severe traumatic brain injury and hypotension from associated injuries needs intubation. The resident says ketamine is contraindicated because it raises intracranial pressure. Discuss.
Presentation
A 35-year-old man with a severe traumatic brain injury (GCS 7), and a concurrent hypotension from his associated injuries, needs urgent intubation in the emergency department. The resident objects to ketamine on the grounds that "it raises intracranial pressure and is contraindicated in head injury."
[4]References2ShowHide
- [4]De Sloovere V, Mebis L, Wouters P, et al. Brain Injury and Ketamine study (BIKe): a prospective randomized controlled trial of ketamine on intracranial pressure in severe TBI. Trials, 2025.PMID 40437634
- [5]Andreasen TH, Olsen MH, Gluud C, Lindschou J, et al. S-ketamine versus placebo for cortical spreading depolarisation in severe acute brain injury (KETA-BID). BMJ Open, 2025.PMID 40721263