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This randomized trial evaluated ketamine and lidocaine as adjuncts to propofol-based TIVA in 150 adults undergoing emergency decompressive craniectomy for traumatic acute subdural hematoma. Mean propofol consumption was significantly lower with ketamine than lidocaine or placebo (100.73 ± 31.72 vs 115.86 ± 38.11 vs 131.53 ± 44.54 μg/kg/min; P<0.001). Ketamine also reduced intraoperative fentanyl requirements (63.85 ± 36.23 vs 83.64 ± 32.27 vs 153.55 ± 57.28 μg; P<0.001) and vasopressor boluses (median 2 vs 3 vs 3; P=0.031). ICP, CPP, brain relaxation, and GOS-E scores were comparable between groups. Lidocaine also showed a modest propofol-sparing effect without adverse effects on measured intracranial dynamics.
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This randomized trial evaluated ketamine and lidocaine as adjuncts to propofol-based TIVA in 150 adults undergoing emergency decompressive craniectomy for traumatic acute subdural hematoma. Mean propofol consumption was significantly lower with ketamine than lidocaine or placebo (100.73 ± 31.72 vs 115.86 ± 38.11 vs 131.53 ± 44.54 μg/kg/min; P<0.001). Ketamine also reduced intraoperative fentanyl requirements (63.85 ± 36.23 vs 83.64 ± 32.27 vs 153.55 ± 57.28 μg; P<0.001) and vasopressor boluses (median 2 vs 3 vs 3; P=0.031). ICP, CPP, brain relaxation, and GOS-E scores were comparable between groups. Lidocaine also showed a modest propofol-sparing effect without adverse effects on measured intracranial dynamics.
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