Pulmonary and Systemic Hemodynamic Responses to Ketamine in Infants with Normal and Elevated Pulmonary Vascular Resistance

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Abstract
Avoidance of ketamine is recommended in children with pulmonary hypertension or with limited right ventricular reserve, despite absence of data about the effects of ketamine on pulmonary vascular resistance (PVR) in children. Ketamine is associated with increased PVR in studies of adults; in these studies, adults were spontaneously breathing through unprotected airways, despite ketamine''s known effects of ventilatory depression and partial loss of airway. Pulmonary and systemic hemodynamic responses to ketamine were measured during spontaneous ventilation in 14 intubated infants who were receiving minimal ventilatory support with an intermittent mandatory ventilation (IMV) of 4, at an FIO2 [fractional inspiratory O2] of 0.3-0.4. No significant changes were found in cardiac index (CI), pulmonary vascular resistance index (PVRI), or systemic vascular resistance index (SVRI) in a group of 7 infants with normal PVRI, or in another group of 7 infants with preexisting increased PVRI. Results did not differ in infants receiving diazepam sedation. Ketamine has little effect on baseline hemodynamics in mildly sedated infants whose airway and ventilation are maintained; in particular, PVRI is little changed by ketamine administration in ventilated infants with either normal or increased baseline PVRI.