Ketamine-induced generalized convulsive seizure during procedural sedation

Abstract

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.

Continuous Infusion of Ketamine for Adjunctive Analgosedation in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease

“…Recent studies have suggested that ketamine has been associated with both the proconvulsant and anticonvulsant effects. [26] In this study, the seizure was not observed in any patients receiving ketamine. Additionally, ketamine use has been associated with hypersalivation which is often managed with glycopyrrolate or atropine.…”

Ketamine: Pro or antiepileptic agent? A systematic review

“…Ketamine has been reported to induce seizures in some cases, which may add to the confusion of clinicians as to its role in patients with a seizure history [ 20 ]. The dilemma is challenging, especially when ketamine is the drug of choice in susceptible patients or those with a history of epilepsy.…”

“…They recommended using ketamine with caution or not at all in patients with epilepsy. Finally, two more recent cases showed ketamine to be implicated in new onset seizures [ 20 , 30 ]. Of note, both cases had the same circumstances; the patients were children, and ketamine was injected intramuscularly for sedation to repair a laceration!…”

Ketamine: Is It Pro-Epileptic or Anti-Epileptic? The Debate Continues. A Narrative Review with a Case Discussion

“…21 Kim et al report a seven-year-old healthy boy who had a seizure following ketamine for sedation to repair a laceration. 22 Interestingly all patients in the paediatric age group. Three patients received IM ketamine (2-4mg/kg) and one patient received 1mg/kg IV ketamine, which are in the accepted dose range.…”

“…There are several case reports on seizure activity following the use of ketamine. 19,20,21,22 Noaimi reports a healthy six-year-old boy who received IV ketamine for a facial laceration repair and developed a tonic clonic seizure for about 30 seconds. 19 Kandrani et al report an otherwise healthy 10-year-old boy patient who received IM ketamine for a tonsillectomy and developed a seizure.…”