Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study
Abstract Objectives There has been controversy over whether ketamine affects intracranial pressure (ICP) in children. Transcranial Doppler ultrasound (TCD) is a validated technique used to assess ICP changes noninvasively. Gosling pulsatility index (PI) directly correlates with ICP changes. The obje...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12760 |
| _version_ | 1818083230841044992 |
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| author | Christopher T. Stem Sriram Ramgopal Robert W. Hickey Mioara D. Manole Jeffrey R. Balzer |
| author_facet | Christopher T. Stem Sriram Ramgopal Robert W. Hickey Mioara D. Manole Jeffrey R. Balzer |
| author_sort | Christopher T. Stem |
| collection | DOAJ |
| description | Abstract Objectives There has been controversy over whether ketamine affects intracranial pressure (ICP) in children. Transcranial Doppler ultrasound (TCD) is a validated technique used to assess ICP changes noninvasively. Gosling pulsatility index (PI) directly correlates with ICP changes. The objective of this study was to quantify PI changes as a surrogate marker for ICP changes in previously healthy children receiving intravenous ketamine for procedural sedation. Methods We performed a prospective, observational study of patients 5–18 years old who underwent sedation with intravenous ketamine as monotherapy. ICP changes were assessed by surrogate PI at baseline, immediately after ketamine administration, and every 5 minutes until completion of the procedure. The primary outcome measure was PI change after ketamine administration compared to baseline (denoted ΔPI). Results We enrolled 15 participants. Mean age was 9.9 ± 3.4 years. Most participants underwent sedation for fracture reduction (87%). Mean initial ketamine dose was 1.4 ± 0.3 mg/kg. PI decreased at all time points after ketamine administration. Mean ΔPI at sedation onset was –0.23 (95% confidence interval [CI] = –0.30 to –0.15), at 5 minutes was –0.23 (95% CI = –0.28 to –0.18), at 10 minutes was –0.14 (95% CI = –0.21 to –0.08), at 15 minutes was –0.18 (95% CI = –0.25 to –0.12), and at 20 minutes was –0.19 (95% CI = –0.26 to –0.12). Using a clinically relevant threshold of ΔPI set at +1 (+8 cm H2O), no elevation in ICP, based on the PI surrogate marker, was demonstrated with 95% confidence at all time points after ketamine administration. Conclusions Ketamine did not significantly increase PI, which was used as a surrogate marker for ICP in this sample of previously healthy children. This pilot study demonstrates a model for evaluating ICP changes noninvasively in the emergency department. |
| first_indexed | 2024-12-10T19:34:42Z |
| format | Article |
| id | doaj.art-f8c5ebd3d7cd463b86b759691a46a2e2 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-10T19:34:42Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-f8c5ebd3d7cd463b86b759691a46a2e22022-12-22T01:36:10ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-08-0134n/an/a10.1002/emp2.12760Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot studyChristopher T. Stem0Sriram Ramgopal1Robert W. Hickey2Mioara D. Manole3Jeffrey R. Balzer4Division of Pediatric Emergency Medicine Department of Pediatrics Medical University of South Carolina Charleston South Carolina USADivision of Emergency Medicine Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago Illinois USADivision of Emergency Medicine Department of Pediatrics UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USADivision of Emergency Medicine Department of Pediatrics UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USADepartment of Neurological Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USAAbstract Objectives There has been controversy over whether ketamine affects intracranial pressure (ICP) in children. Transcranial Doppler ultrasound (TCD) is a validated technique used to assess ICP changes noninvasively. Gosling pulsatility index (PI) directly correlates with ICP changes. The objective of this study was to quantify PI changes as a surrogate marker for ICP changes in previously healthy children receiving intravenous ketamine for procedural sedation. Methods We performed a prospective, observational study of patients 5–18 years old who underwent sedation with intravenous ketamine as monotherapy. ICP changes were assessed by surrogate PI at baseline, immediately after ketamine administration, and every 5 minutes until completion of the procedure. The primary outcome measure was PI change after ketamine administration compared to baseline (denoted ΔPI). Results We enrolled 15 participants. Mean age was 9.9 ± 3.4 years. Most participants underwent sedation for fracture reduction (87%). Mean initial ketamine dose was 1.4 ± 0.3 mg/kg. PI decreased at all time points after ketamine administration. Mean ΔPI at sedation onset was –0.23 (95% confidence interval [CI] = –0.30 to –0.15), at 5 minutes was –0.23 (95% CI = –0.28 to –0.18), at 10 minutes was –0.14 (95% CI = –0.21 to –0.08), at 15 minutes was –0.18 (95% CI = –0.25 to –0.12), and at 20 minutes was –0.19 (95% CI = –0.26 to –0.12). Using a clinically relevant threshold of ΔPI set at +1 (+8 cm H2O), no elevation in ICP, based on the PI surrogate marker, was demonstrated with 95% confidence at all time points after ketamine administration. Conclusions Ketamine did not significantly increase PI, which was used as a surrogate marker for ICP in this sample of previously healthy children. This pilot study demonstrates a model for evaluating ICP changes noninvasively in the emergency department.https://doi.org/10.1002/emp2.12760intracranial pressureketaminepulsatility indexsedationtranscranial Dopplerultrasound |
| spellingShingle | Christopher T. Stem Sriram Ramgopal Robert W. Hickey Mioara D. Manole Jeffrey R. Balzer Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study Journal of the American College of Emergency Physicians Open intracranial pressure ketamine pulsatility index sedation transcranial Doppler ultrasound |
| title | Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study |
| title_full | Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study |
| title_fullStr | Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study |
| title_full_unstemmed | Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study |
| title_short | Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study |
| title_sort | effect of ketamine on transcranial doppler gosling pulsatility index in children undergoing procedural sedation a pilot study |
| topic | intracranial pressure ketamine pulsatility index sedation transcranial Doppler ultrasound |
| url | https://doi.org/10.1002/emp2.12760 |
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