Letter to the Editor
My first reaction was that Blake Briggs, MD was going too far to defend one of his residents. (“Why are we still talking about ICP and ketamine?” REM. 2022;44:27; https://bit.ly/35LANFe.)
That there is a lack of evidence that ketamine causes worse outcomes in TBI says little. The lack of evidence does not mean that there is evidence to the contrary, especially because the TBI includes not only hemorrhage, but also ischemic stroke in the catch-all term. Without strong, direct evidence comparing the outcomes of hemorrhage in ketamine versus other induction agents, few conclusions about safety can be drawn.
Despite the fact that there is an expected systemic hypertensive response that patients typically have with ketamine flares, I was surprised to learn of the literature supporting the mechanism of cerebral dilation. Also, there is no article in PubMed or Google Scholar that I could find supporting that ketamine worsens intracranial hemorrhage.
Christopher Lee Taicher, MD
Culver City, California