Which intravenous anesthetic is contraindicated in patients with intracranial hypertension?

Which intravenous anesthetic is contraindicated in patients with intracranial hypertension?

• A. Propofol
• B. Fentanyl
• C. Thiopental
• D. Ketamine

Answer: (D)

In intracranial hypertension, the goal is to decrease cerebral blood flow and metabolic demand to lower intracranial pressure. Ketamine is contraindicated because it tends to raise ICP. It increases cerebral blood flow and cerebral metabolic rate, partly through sympathetic stimulation and cerebral vasodilation, which adds more blood volume to an already swollen brain. This can worsen brain edema and reduce cerebral perfusion pressure. In contrast, agents like propofol and thiopental reduce ICP by lowering cerebral metabolic rate and cerebral blood flow, helping to control intracranial pressure. Fentanyl provides analgesia with relatively neutral effects on ICP when used carefully. So the drug that should be avoided in intracranial hypertension is ketamine.

In intracranial hypertension, the goal is to decrease cerebral blood flow and metabolic demand to lower intracranial pressure. Ketamine is contraindicated because it tends to raise ICP. It increases cerebral blood flow and cerebral metabolic rate, partly through sympathetic stimulation and cerebral vasodilation, which adds more blood volume to an already swollen brain. This can worsen brain edema and reduce cerebral perfusion pressure.

In contrast, agents like propofol and thiopental reduce ICP by lowering cerebral metabolic rate and cerebral blood flow, helping to control intracranial pressure. Fentanyl provides analgesia with relatively neutral effects on ICP when used carefully. So the drug that should be avoided in intracranial hypertension is ketamine.