Journal of Anesthesia

, Volume 28, Issue 6, pp 821–827 | Cite as

Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials

  • Xin Wang
  • Xibing Ding
  • Yao Tong
  • Jiaying Zong
  • Xiang Zhao
  • Hao Ren
  • Quan LiEmail author
Original Article



Ketamine 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.


We 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.


Five 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).


The 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.


Ketamine Opioids Intracranial pressure Hemodynamic instability Brain injuries 



We are grateful for the support from the National Natural Science Foundation. We also thank all authors of the publications included in this study for contributing information as requested.


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Copyright information

© Japanese Society of Anesthesiologists 2014

Authors and Affiliations

  • Xin Wang
    • 1
    • 2
  • Xibing Ding
    • 1
  • Yao Tong
    • 1
  • Jiaying Zong
    • 1
    • 2
  • Xiang Zhao
    • 1
  • Hao Ren
    • 1
  • Quan Li
    • 1
    • 3
    Email author
  1. 1.Department of AnesthesiologyShanghai Tenth People’s Hospital, Tongji University School of MedicineShanghaiChina
  2. 2.First Clinical Medical College of Nanjing Medical UniversityNanjingChina
  3. 3.Department of AnesthesiologyEast Hospital, Tongji University School of MedicineShanghaiChina

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