Possible gabapentin and ketamine interaction causing prolonged central nervous system depression during post-operative recovery following cervical laminoplasty: a case report

Elyassi, Ali R.; Long, Robert P.; Bejnarowicz, Robert P; Schoneboom, Bruce A.

doi:10.1186/1752-1947-5-167

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…22 A case of lengthened recovery from GA due to gabapentin/ketamine interaction was also reported. 23 …”

Section: Causes Of Delayed Emergencementioning

confidence: 99%

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<p>Delayed Emergence from Anesthesia: What We Know and How We Act</p>

Cascella¹,

Bimonte²,

Napoli³

2020

LRA

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The emergence from anesthesia is the stage of general anesthesia featuring the patient’s progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the “active awakening” are reported.

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“…22 A case of lengthened recovery from GA due to gabapentin/ketamine interaction was also reported. 23 …”

Section: Causes Of Delayed Emergencementioning

confidence: 99%

“…22 A case of lengthened recovery from GA due to gabapentin/ketamine interaction was also reported. 23 A reduced volume of distribution and plasma protein binding leads to an increased drug-free plasma concentration with an enhancement of the drug effect. This aspect is very important in fragile patients with hypoalbuminemia.…”

Section: Pharmacokinetic Causesmentioning

confidence: 99%

<p>Delayed Emergence from Anesthesia: What We Know and How We Act</p>

Cascella¹,

Bimonte²,

Napoli³

2020

LRA

View full text Add to dashboard Cite

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“…The reason behind this was the drug interaction. Elyassi AR et al 27 . have illustrated the potential drug interaction between gabapentin and ketamine, which caused delayed recovery of patients undergoing cervical laminoplasty.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study

Zhang

Xuan

et al. 2023

International Journal of Surgery

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Background: Delayed recovery in the postanesthesia care unit (PACU) after surgery, as a severe occurrence, influences enhanced recovery after surgery. The data from the observational clinical study is a paucity. Materials and Methods: This large, retrospective, and observational cohort study initially included 44 767 patients. The primary outcome was risk factors for delayed recovery in PACU. A generalized linear model and nomogram were employed to identify risk factors. Discrimination and calibration were used to evaluate the performance of the nomogram via internal and external validation. Results: Of 38 796 patients, 21 302 (54.91%) were women. The delayed recovery aggregate rate was 1.38% [95% CI, (1.27, 1.50%)]. In a generalized linear model, risk factors for delayed recovery were old age [RR, 1.04, 95% CI, (1.03,1.05), P<0.001], neurosurgery [RR, 2.75, 95% CI, (1.60, 4.72), P<0.001], using antibiotics during surgery [RR, 1.30, 95% CI, (1.02, 1.66), P=0.036], long anesthesia duration [RR, 1.0025, 95% CI, (1.0013, 1.0038), P<0.001], ASA grade of III [RR, 1.98, 95% CI, (1.38, 2.83), P<0.001], and postoperative analgesia [RR, 1.41, 95% CI, (1.10, 1.80), P=0.006]. In the nomogram, old age and neurosurgery had high scores in the model and contributed significantly to the increased probability of delayed recovery. The area under the curve value of the nomogram was 0.77. The discrimination and calibration of the nomogram estimated by internal and external validation were generally satisfactory. Conclusion: This study demonstrates that delayed recovery in PACU after surgery was associated with old age, neurosurgery, long anesthesia duration, an ASA grade of III, using antibiotics during surgery, and postoperative analgesia. These findings provide predictors of delayed recovery in PACU, especially neurosurgeries and old age.

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“…Dysfunction of these neural systems has been connected to several neuropsychiatric disturbances (depression, ADHD, etc.). The neuroapoptotic effects of long-term ketamine use are similar to aging processes and Alzheimer’s disease [ 121 , 122 , 123 , 124 ]. Regarding psychiatric side effects, depression was found to worsen over a year in both daily and former ketamine users.…”

Section: Adverse Effects and Interactions Of Ketaminementioning

confidence: 99%

Ketamine, an Old–New Drug: Uses and Abuses

Savić Vujović,

Jotić,

Medić

et al. 2023

Pharmaceuticals

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Ketamine as an old–new drug has a variety of clinical implications. In the last 30 years, ketamine has become popular for acute use in humans. Ketamine in standard doses is principally utilized for the induction and maintenance of surgical procedures. Besides its use in anesthesia and analgesia, recent studies have shown that ketamine has found a place in the treatment of asthma, epilepsy, depression, bipolar affective disorders, alcohol and heroin addiction. Ketamine primarily functions as a noncompetitive antagonist targeting the N-methyl-D-aspartate (NMDA) receptor, but its mechanism of action is complex. It is generally regarded as safe, with low doses and short-term use typically not leading to significant adverse effects. Also, ketamine is known as a powerful psychostimulant. During the past decade, ketamine has been one of the commonly abused drugs.

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Possible gabapentin and ketamine interaction causing prolonged central nervous system depression during post-operative recovery following cervical laminoplasty: a case report

Cited by 13 publications

References 12 publications

<p>Delayed Emergence from Anesthesia: What We Know and How We Act</p>

<p>Delayed Emergence from Anesthesia: What We Know and How We Act</p>

Risk factors for delayed recovery in postanesthesia care unit after surgery: a large and retrospective cohort study

Ketamine, an Old–New Drug: Uses and Abuses

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