PMID- 23409639
OWN - NLM
STAT- MEDLINE
DCOM- 20130312
LR  - 20131121
IS  - 0094-6354 (Print)
IS  - 0094-6354 (Linking)
VI  - 80
IP  - 6
DP  - 2012 Dec
TI  - Rethinking the paradigm: evaluation of ketamine as a neurosurgical anesthetic.
PG  - 445-52
AB  - Although anesthetists have long assumed that ketamine's role in neuroanesthesia 
      is limited because of its association with increased intracranial pressure, this 
      article presents a review of recent clinical literature suggesting otherwise. 
      When ketamine is used as an adjuvant anesthetic agent along with mechanical 
      ventilation to maintain normocapnia, ketamine does not have adverse cerebral 
      hemodynamic effects. Furthermore, ketamine possesses a unique pharmacologic 
      profile that provides analgesia, bronchodilation, and sympathetic stimulation, 
      thereby reducing patients' vasoactive agent requirements. Caution must be 
      exercised because of ketamine's action at the N-methyl-D-aspartate receptor 
      (NMDAR), as ketamine may antagonize both neuroprotective and neurodestructive 
      NMDAR-mediated pathways. Still, ketamine may prove to be a safe part of a 
      neuroanesthetic regimen, and it should no longer be considered absolutely 
      contraindicated as a result of its cerebral hemodynamic effects.
FAU - Bowles, Eric D
AU  - Bowles ED
AD  - Keck Medical Center, University of Southern California, Los Angeles, California, 
      USA. ericbowles@gmail.com
FAU - Gold, Michele E
AU  - Gold ME
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - AANA J
JT  - AANA journal
JID - 0431420
RN  - 0 (Anesthetics, Dissociative)
RN  - 690G0D6V8H (Ketamine)
EIN - AANA J. 2013 Feb;81(1):18
MH  - Anesthetics, Dissociative/*administration & dosage/adverse effects
MH  - Cerebrovascular Circulation/*drug effects
MH  - Humans
MH  - Ketamine/*administration & dosage/adverse effects
MH  - *Nurse Anesthetists
MH  - Sympathetic Nervous System/*drug effects
EDAT- 2013/02/16 06:00
MHDA- 2013/03/13 06:00
CRDT- 2013/02/16 06:00
PHST- 2013/02/16 06:00 [entrez]
PHST- 2013/02/16 06:00 [pubmed]
PHST- 2013/03/13 06:00 [medline]
PST - ppublish
SO  - AANA J. 2012 Dec;80(6):445-52.