Ketamine for rapid sequence induction in patients with head injury in the emergency department.

OBJECTIVE To examine the evidence regarding the use of ketamine for induction of anaesthesia in patients with head injury in the ED. METHOD A literature review using the key words ketamine, head injury and intracranial pressure. RESULTS Advice from early literature guiding against the use of ketamine in head injury has been met with widespread acceptance, as reflected by current practice. That evidence is conflicting and inconclusive in regards to the safety of using ketamine in head injury. A review of the literature to date suggests that ketamine could be a safe and useful addition to our available treatment modalities. The key to this argument rests on specific pharmacological properties of ketamine, and their effects on the cerebral haemodynamics and cellular physiology of brain tissue that has been exposed to traumatic injury. CONCLUSION In the modern acute management of head-injured patients, ketamine might be a suitable agent for induction of anaesthesia, particularly in those patients with potential cardiovascular instability.