Lasting s-ketamine block of spreading depolarizations in subarachnoid hemorrhage: a retrospective cohort study
Spreading depolarizations (SD) are characterized by breakdown of transmembrane ion gradients and excitotoxicity. Experimentally, N-methyl-d-aspartate receptor (NMDAR) antagonists block a majority of SDs. In many hospitals, the NMDAR antagonist s-ketamine and the GABAA agonist midazolam represent the...
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| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
30 December 2019
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| In: |
Critical care
Year: 2019, Volume: 23, Pages: 1-14 |
| ISSN: | 1466-609X |
| DOI: | 10.1186/s13054-019-2711-3 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1186/s13054-019-2711-3
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| Author Notes: | Edgar Santos, Arturo Olivares-Rivera, Sebastian Major, Renán Sánchez-Porras, Lorenz Uhlmann, Kevin Kunzmann, Roland Zerelles, Modar Kentar, Vasilis Kola, Adrian Hernández Aguilera, Mildred Gutierrez Herrera, Coline L. Lemale, Johannes Woitzik, Jed A. Hartings, Oliver W. Sakowitz, Andreas W. Unterberg, and Jens P. Dreier |
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| 520 | |a Spreading depolarizations (SD) are characterized by breakdown of transmembrane ion gradients and excitotoxicity. Experimentally, N-methyl-d-aspartate receptor (NMDAR) antagonists block a majority of SDs. In many hospitals, the NMDAR antagonist s-ketamine and the GABAA agonist midazolam represent the current second-line combination treatment to sedate patients with devastating cerebral injuries. A pressing clinical question is whether this option should become first-line in sedation-requiring individuals in whom SDs are detected, yet the s-ketamine dose necessary to adequately inhibit SDs is unknown. Moreover, use-dependent tolerance could be a problem for SD inhibition in the clinic. | ||
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