Ketamine-induced catalepsy during adult sedation in the Emergency Department.

Abstract

BACKGROUND:

Ketamine continues to rise in popularity for procedural sedation in the Emergency Department (ED) for both adult and pediatric patients. The medication has a good safety profile and is well tolerated in the majority of patients. However, the Emergency Physician should be aware of the full range of side-effects that may be encountered, so as to best anticipate and prepare for potential complications.

OBJECTIVES:

We describe two cases of catalepsy (muscle hypertonia with dissociation) in patients undergoing sedation with ketamine.

CASE REPORT:

In the first case, a patient presented to the ED after a prehospital awake nasal intubation for an exacerbation of chronic obstructive pulmonary disease. After sedation with ketamine, he was extubated and transitioned to bi-level positive pressure ventilation. Shortly after receiving ketamine, he exhibited severe muscular hypertonia of the upper extremities with facial grimacing. A second patient underwent ketamine sedation for reduction of a shoulder dislocation. After medication administration, he exhibited full body muscular hypertonicity, interfering briefly with the procedure. In both patients, catalepsy resolved spontaneously.

CONCLUSIONS:

Ketamine-induced catalepsy is a self-limited side-effect that has the potential to interfere with procedures performed under sedation.

• Authors: Corey R Heitz, J Ryan Bence
• Journal: The Journal of emergency medicine (J Emerg Med) Vol. 44 Issue 2 Pg. e243-5 (Feb 2013) ISSN: 0736-4679 [Print] United States
• PMID: 22999776 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Anesthetics, Dissociative
• Ketamine

Topics

• Adult
• Anesthetics, Dissociative (administration & dosage, adverse effects)
• Catalepsy (chemically induced)
• Emergency Service, Hospital
• Humans
• Ketamine (administration & dosage, adverse effects)
• Male
• Middle Aged