Safety of sedation with ketamine in severe head injury patients: Comparison with sufentanil

82 25 g·kg 1 ·min 1 ketamine and 1.64 0.5 g·kg 1 ·min 1 midazolam in the ketamine group and 0.008 0.002 g·kg 1 ·min 1 sufentanil and 1.63 0.37 g·kg 1 ·min 1 midazolam in the sufentanil group. No significant differences were observed between the two groups in the mean daily values of intracranial pressure and cerebral perfusion pressure. The numbers of intracranial pressure elevations were similar in both groups. The requirements of neuromuscular blocking agents, propofol, and thiopental were similar. Heart rate values were significantly higher in the ketamine group on therapy days 3 and 4( p < .05). With regard to arterial pressure control, more fluids were given on the first therapy day and there was a trend toward greater use of vasopressors in the sufentanil group. Sedative costs were similar in the two groups. Conclusion: The results of this study suggest that ketamine in combination with midazolam is comparable with a combination of midazolam-sufentanil in maintaining intracranial pressure and cerebral perfusion pressure of severe head injury patients placed under controlled mechanical ventilation. (Crit Care Med 2003; 31:711‐717)