Which of the following drugs is contraindicated in a patient with raised intracranial pressure ?
Correct Answer: Ketamine
Description: Ans. is 'd' i.e.. Ketamine o Cerebral blood flow, metabolism, oxygen consumption and ICT all are increased by ketamine - ketamine is contraindicated in raised ICT.o Ketamine is a potent bronchodilator.o Ketamine increases BP and ICT.o Airway reflexes (pharyngeal and laryngeal) are not depressed.Ketamineo The primary site of action is in the cortex and subcortical areas; not in the reticular activating system (site of action of barbiturates),o It acts on NMDA receptors.o Short duration of action (10-15 minutes) is due to redistribution from brain and blood to other tissues of the body,o Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action.o Ketamine increases IOT and cerebral metabolism - contraindicated in head injury.o It causes sympathetic stimulation with elevation of HR, CO & BP - contraindicated in hypertension and ischemic heart disease.o It also raises IOT - contraindicated in glaucoma.o It relieves bronchospasm - intravenous anaesthetic of choice in asthmatics (inhalation anaesthetic of choice in asthmatic is halothane).o Injection is not painful (All other inducing agents cause pain on injection),o It is i.v. anaesthetic of choice in children (Sevoflurane is inhalation agent of choice).o Because it causes sympathetic stimulation it is intravenous anaesthetic of choice in patients with shock and hypovolumia.o It has no muscle relaxant property rather muscle tone is increased.o Airway reflexes (pharyngeal and laryngeal) are not depressed - intravenous anaesthetic of choice for emergency anaesthesia (no starvation is required).o Ketamine produces emergence reaction during awakening from anaesthesia - vivid dreaming, illusions, extracorporeal experiences, excitment, confusion, fear and euphoria - contraindicated in psychiatric illness like schizophrenia.
Category:
Anaesthesia
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