Pilot Study of Ketamine Sedation for Aneurysmal Subarachnoid Hemorrhage
Status:
Not yet recruiting
Trial end date:
2023-07-01
Target enrollment:
Participant gender:
Summary
Aneurysmal subarachnoid hemorrhage (aSAH) is bleeding into the space between the brain and
the tissues that surround the brain as a result of a ruptured aneurysm and is a type of
stroke associated with high morbidity and mortality. Those that survive the initial bleed are
critically ill and require prolonged intensive care unit stays since they are at risk for a
multitude of secondary insults that can further worsen functional outcomes. An especially
feared secondary insult is delayed cerebral ischemia (DCI), which is a lack of blood flow to
a particular portion of the brain that can result in an ischemic stroke and produce profound
neurologic deficits. How DCI develops in some people after aSAH and not others is unknown,
but many have hypothesized various mechanisms such as 1) cerebral vasospasm, a focal anatomic
narrowing of the blood vessels in the brain that could decrease downstream blood flow, 2)
abnormal electrical activity, and 3) microthrombi, or the formation of small blood clots.
It is vitally important to identify a therapy that could protect the brain from these
secondary insults that happen days after the initial brain bleed. Ketamine is a drug used in
the majority of hospitals around the world for various indications, including general
anesthesia, sedation, and for pain. Ketamine blocks a specific receptor that is present
within the brain and in doing so could play a critical protective role against these
secondary insults after aSAH by blocking the flow of dangerous chemicals. Ketamine may
provide the following beneficial properties after aSAH: 1) pain control, 2) seizure
prevention, 3) blood pressure support, 4) dilation of the brain blood vessels, 5) sedation,
6) anti-depressant, and 7) anti-inflammatory. This project is designed to test whether
ketamine sedation in the intensive care unit after aneurysm repair provides better outcomes
than the currently used sedation regimen.