Ketamine Implicated in New Onset Seizure

Abstract

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation and pain management. A major benefit of using ketamine is the rapid onset and lack of respiratory depression. The known side effects include emergence reactions, hallucinations, hypertension, dizziness, nausea, and vomiting. Recent studies have shown the benefit of ketamine for refractory status epilepticus; however, this application of the drug is still being studied. We present a case where ketamine likely induced a seizure in a patient on whom it was used as a single agent in procedural sedation. Seizure is not a known side effect of ketamine in patients without a seizure history. Given the eagerness over additional uses for ketamine, this novel case of a seizure following procedural sedation with ketamine should be of interest to emergency providers.

A Review of Nonanesthetic Uses of Ketamine

“…Furthermore, other novel uses of ketamine for seizure disorders are currently being investigated; for example, recently a case was reported in which low-dose IV ketamine was used in an epileptic patient with postoperative worsening of his seizure burden, with successful improvement in seizures and avoidance of oversedation or intubation [179]. However, it has also been recently called into question whether ketamine may induce seizure in some cases, with one recent case of new-onset seizure being reported following intramuscular ketamine administration in a pediatric patient, which certainly warrants further consideration as well [180].…”

Ketamine-induced generalized convulsive seizure during procedural sedation

“…It is considered relatively safe when used with proper precautions in the emergency department and has been successfully administered to patients for procedures, such as laceration repair. As plastic surgeons, we have become more comfortable with the use of this drug regularly for procedural sedation in pediatric patients because of its rapid onset of effects, relatively short half-life, and lack of respiratory depression [ 5 ]. Ketamine has been used for the treatment of delirium, depression, and schizophrenia, and for its analgesia and anti-inflammatory effects [ 2 ].…”

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

“…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.…”

“…She was a known patient with autism with a stable mental status and CT brain showed mild colpocephaly of the ventricles of uncertain significance and a normal one-hour EEG. 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.…”