SynthesisJournal of anesthesia2014
Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials.
Synthesis in Journal of anesthesia, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- Ketamine for Critically Ill Patients with Severe Acute Brain Injury: A Systematic Review with Meta-analysis and Trial Sequential Analysis of Randomized Clinical Trials.Neurocritical care · 2025Pooled it
- Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version.German medical science : GMS e-journal · 2015Guideline
- Impact of Low-Dose Ketamine Infusion on Intracranial Pressure and Hemodynamics in Septic Shock Patients.Neurocritical care · 2026Trial
- Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study.Neurocritical care · 2026Trial
- Optimizing ketamine dosing strategies across diverse clinical applications: a comprehensive review.Annals of medicine and surgery (2012) · 2025Review
- Ketamine-Ethanol Combination Decreases Reduced Glutathione Levels and Activates both Intrinsic and Extrinsic Apoptotic Pathways Prior to Neuronal Death in SH-SY5Y Cells.Neurotoxicity research · 2025Article
- High risk and low incidence diseases: Aneurysmal subarachnoid hemorrhage.The American journal of emergency medicine · 2025Review
- Co-administration of Ketamine in Pediatric Patients with Neurologic Conditions at Risk for Intracranial Hypertension.Neurocritical care · 2023Observational
- Ketamine is not associated with more post-intubation hypotension than etomidate in patients undergoing endotracheal intubation.The American journal of emergency medicine · 2022Article
- A dose-escalation clinical trial of intranasal ketamine for uncontrolled cancer-related pain.Pharmacotherapy · 2022Article
- Effect of Anesthetics on Functional Connectivity of Developing Brain.Frontiers in human neuroscience · 2022Review
- Ketamine in acute phase of severe traumatic brain injury "an old drug for new uses?"Critical care (London, England) · 2021Article
- Article
- Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury.Frontiers in neurology · 2020Review
- [Ketamine in the therapy of chronic pain and depression].Wiener medizinische Wochenschrift (1946) · 2019Review
- Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2018Review
- Article
- Collective Review of the Status of Rapid Sequence Intubation Drugs of Choice in Trauma in Low- and Middle-Income Settings (Prehospital, Emergency Department and Operating Room Setting).World journal of surgery · 2017Review
- Ketamine: 50 Years of Modulating the Mind.Frontiers in human neuroscience · 2016Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundKetamine is traditionally avoided in sedation management of patients with risk of intracranial hypertension. However, results from many clinical trials contradict this concern. We critically analyzed the published data of the effects of ketamine on intracranial pressure (ICP) and other cerebral hemodynamics to determine whether ketamine was safe for patients with hemodynamic instability and brain injuries.
methodsWe systematically searched the online databases of PubMed, Medline, Embase, Current Controlled Trials, and Cochrane Central (last search performed on January 15, 2014). Trial characteristics and outcomes were independently extracted by two assessors (Xin Wang, Xibing Ding). For continuous data, mean differences (MD) were formulated. If the P value of the chi-square test was >0.10 or I(2) <50%, a fixed-effects model was used; otherwise, the random effects model was adopted.
resultsFive trials (n = 198) met the inclusion criteria. Using ICP levels within the first 24 h of ketamine administration as the main outcome, the use of ketamine leads to the same ICP levels as opioids [MD = 1.94; 95% confidence interval (95% CI), -2.35, 6.23; P = 0.38]. There were no significant differences in mean arterial pressure values between the two groups (MD = 0.99; 95% CI, -2.24, 4.22; P = 0.55). Ketamine administration was also comparable with opioids in the maintenance of cerebral perfusion pressure (MD = -1.07; 95% CI, -7.95, 5.8; P = 0.76).
conclusionsThe results of this study suggest that ketamine does not increase ICP compared with opioids. Ketamine provides good maintenance of hemodynamic status. Clinical application of ketamine should not be discouraged on the basis of ICP-related concerns.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.