Ketamine for Brain Injury

Ketamine serves as a versatile, underutilized agent in the management of moderate to severe traumatic brain injury. While historical dogma suggests ketamine exacerbates intracranial pressure, this concern stems from flawed 1972 research that failed to account for respiratory confounders. Modern evidence indicates that ketamine is safe, maintains cardiovascular stability, and potentially ameliorates excitotoxic secondary brain injury by antagonizing NMDA receptors and reducing the frequency of cortical spreading depolarizations. Unlike traditional GABA-agonist sedatives, ketamine does not accumulate as rapidly, offering distinct advantages for long-term sedation. Current clinical efforts, such as the pilot feasibility study at the Alfred, aim to validate these benefits and challenge existing neurocritical care practices. By sparing patients from excessive doses of traditional sedatives and preventing secondary neurological damage, ketamine represents a promising shift in clinical protocols for brain-injured patients.