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What is Ketamine is contraindicated in? and explain in detail?
Ans is 'c' i.e., Glaucoma Contraindications of Ketamine1. CNS - Ketamine increases cerebral blood flow, metabolism, oxygen consumption and intracranial tension, unlike thiopentone, propofol & etomidate which have cerebroprotective effect - Ketamine is contraindicated in head injury, Intracranial space occupying lesion and for neuro-anesthesia. Cerebrovascular responsiveness to CO2 is preserved, and reducing the arterial CO2 tension by hyperventilation attenuates the ketamine induced rise in ICT.2. Cardiovascular - Ketamine has direct myocardial depressant (negative ionotropic) & vasodilator effect. However, ketamine also has indirect sympathomimetic effect. Indirect sympathomimetic effect predominates over direct myocardial depressant & vasodilator effect; usual response is increased BP, cardiac output and heart rate - Cardiac O2 demand is increased - Ketamine is contraindicated in aortic aneurysm, hypertensive and ischemic heart disease. Ketamine also sensitizes the heart to adrenaline - arrhythmias may occur. As ketamine cause sympathetic stimulation it is intravenous anesthetic of choice in patients with shock and hypovolemia.3. Ketamine increases intra-ocular tension - Contraindicated in glaucoma & open eye surgery.