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The longterm effects of ketamine on haemodynamic parameters and exogenous catecholamine requirements were studied in twenty-five critically ill patients with catecholamine-dependent heart failure. Following sedation with midazolam (0.15±0.07 mg.kg –1 .h –1 ) and sufentanil (0.88±0.33 μg.kg –1 .h –1 ), patients with impaired left ventricular function (left ventricular ejection fraction area 30±7%) were randomly assigned to receive ketamine (2.5±0.9 mg.kg –1 .h –1 ) and midazolam (Group A) or remained on sufentanil/midazolam (Group B). Haemodynamic measurements were performed throughout the first 24 hours after randomization. In group A cardiac index decreased by 21% (P=0.01), mean arterial pressure increased by 13% (P=0.01), mean pulmonary artery pressure by 14% (P=0.04), pulmonary capillary wedge pressure by 20% (P=0.03), and systemic vascular resistance index by 38% (P&lt;0.001). No significant cardiovascular effects were observed in Group B. Neither group had significant changes of exogenous catecholamine requirement.    In conclusion, ketamine exhibits potential negative cardiovascular effects in patients with catecholamine-dependent heart failure. Therefore, ketamine should not be considered a first line drug for longterm sedation of patients with impaired left ventricular function.

Adverse Cardiovascular Effects of Ketamine Infusion in Patients with Catecholamine-Dependent Heart Failure