Q182.

Which of the following is contraindicated in an epileptic patient posted for

general anaesthesia?
A
B
C
D

Propofol
Thiopentone
Ketamine
Midazolam

Answer: C (Ketamine)
Explanation: (Morgan 4th/ 197-99, Ajay Yadav 3rd 73-75)
Ketamine should be avoided in patients of epilepsy as it increases
intracranial pressure, increase cerebral oxygen consumption, cerebral
blood flow and also causes delirium and hallucinations.
Ketamine:

Phencyclidine derivative, conatins benzthonium chloride as preservative.

Acts on NMDA receptors
Dose is 2mg/kg intravenous
Early regain of consciousness id due to redistribution.
Strong analgesic
Increases muscle tone
Primary site of action is thalamocortical projection, inhibits
cortex(causes unconsciousness)and thalamus (analgesia), stimulates
limbic system (emergence reaction and hallucinations)
Produces dissociative anaesthesia and individual is in cataleptic
state.
Systemic effects:
1 CNS:
Increases brain oxygen consumption and metabolic rate
Intracranial tension is highly raised.
Emergence reactions (vivid dreaming, illusions) are seen.
Hallucinations: both auditory (mainly) and visual are seen. The
incidence is 30-40%. Hallucinations are most common side
effect of ketamine. These emergence reactions and
hallucinations can be decreased by the use of benzodiazepines
with ketamine.
2 CVS:
Stimulates sympathetic system
Tachycardia
Hypertension
Increased oxygen demand by myocardium
Anesthetic agent of choice for shock
Benzodiazepines attenuate this hemodynamic response.
3 Respiratory system:
Stimulates respiration
Potent bronchodilator
Anesthetic agent of choice for asthamatics

 Pharyngeal and laryngeal reflexes are preserved.

Tracheobronchial and salivary secretions are increased.
4 Eye:
Increased intraocular tension
5 GIT:
Increased intragastric pressure
Salivary secretions are increased
6 Muscular system
Increases muscle tone
Advantages & Uses:
1

2
3

Induction agent of choice for:

Asthamatics
Shock
Constrictive pericarditis, cardiac tamponade (in these
conditions the cardiac output is dependent upon tachycardia,
ketamine causes tachycardia)
Right to left shunt like TOF (ketamine by causing
hypertension increases the afterload thereby decreasing the
right to left shunt fraction)
Used as sole agent for minor procedures, can be used in remote places
Preferred agent for patients with full stomach as pharyngeal and
laryngeal reflexes is preserved.

Contraindiactions of ketamine:
1
2
3
4
5
6
7

Head injury
Space occupying intracranial lesions
Eye injuries
Ischaemic heart disease
Vascular aneurysm
Hypertension
Psychiatric diseases and drug addicts

Thiopentone:

Decreases cerebral oxygen consumption, cerebral metabolic rate and

intracranial tension
Agent of choice for cerebral protection
Anticonvulsant action due to phenyl group

Propofol:

Decreases intracranial pressure

Neuroprotective

Midazolam:

Benzodiazepine with anti seizure potential

Used in treating seizures.