Ketamine
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Pulmonary hypertensive crisis in children: 2 case reports Two children, who had congenital heart disease, developed pulmonary hypertensive crisis following ketamine administration during transcatheter occlusion surgery. A 4-year-old 15kg boy received IV ketamine 2 mg/kg via a slow bolus injection, followed by a second ketamine dose of 1 mg/kg 15 minutes later. Thirty seconds later, he developed severe dyspnoea and cyanosis with an SpO2 of 51% and a HR of 64/min. He was given oxygen in a facemask, but increased airway resistance was noted and a laryngoscopy found laryngeal oedema and tonsil swelling. He was given dexamethasone and atropine with normalisation of oxygen saturation and HR. A reaction to the contrast medium was suspected, and his surgery was cancelled. Six days later, he underwent surgery again, and was given IV ketamine 2 mg/kg. One minute later, dyspnoea and cyanosis recurred and his SpO2 dropped to 82%. Ketamine was suspected. He was given oxygen and assisted respiration, dexamethasone and propofol, and was intubated under anaesthesia with sevoflurane. Surgery lasted for 50 minutes. He recovered autonomous respiration and regained consciousness; the tracheal cannula was removed. However, breathing difficulties emerged with an SpO2 of 82%, and he required oxygen via a face mask. His symptoms persisted 100 minutes later (150 minutes since ketamine administration). His BP continued to decrease to 65/35mm Hg and his pulmonary arterial pressure was estimated at 124mm Hg suggestive of pulmonary hypertensive crisis. He received dopamine, sodium nitroprusside and furosemide, and was transferred to the ICU; his condition gradually improved and stabilised. He was transferred back to the ward, and given sodium nitroprusside, alprostadil, and other symptomatic treatments. He was discharged in good condition 17 days after surgery. A 6-year-old girl received IV ketamine 2 mg/kg as a slow injection; 15 minutes later, she received another dose of ketamine 20mg. One minute later, she developed severe dyspnoea difficulties, cyanosis and a choking cough. Haemorrhagic discharge was suctioned out of her mouth, but her SpO2 dropped to 80% and her HR increased to 160/min. She had an estimated pulmonary arterial pressure of 86mm Hg. She was immediately given dexamethasone, deslanoside and oxygen via a facemask with assisted ventilation. Her vital signs gradually normalised with her SpO2 increasing to 99% and her pulmonary arterial pressure decreasing to 43mm Hg. Her surgery was completed without further complications. She was discharged in a stable condition and with normal echocardiography findings 4 days later. Zhang Z, et al. Pulmonary arterial hypertension crisis caused by ketamine administration during transcatheter occlusion for ventricular septal defect in children with congenital heart diseases: A report of 2 cases. Academic Journal of Second Military Medical University 30: 1160-1161, No. 10, Oct 2010. Available from: URL: http://dx.doi.org/10.3724/sp.j.1008.2010.01160 [Chinese; summarised 803048598 from a tra
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