Recurrent episodes of intractable laryngospasm followed by laryngeal and pulmonary oedema during dissociative anaesthesia with intravenous ketamine

Baduni, Neha; Sanwal, Manoj Kumar; Jain, Aparna; Kachru, Nisha

doi:10.4103/0019-5049.68395

Cited by 9 publications

(10 citation statements)

References 3 publications

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“…In this paper, we studied the effects of ketamine on human alveolar epithelial fluid clearance which has important clinical significance. First, several case reports have shown that ketamine is a possible reason for lung edema in patients during intraoperative period [ 1 – 3 , 5 ]. If this effect occurred at the level of the alveolar or distal airway epithelium, then the threshold for developing alveolar edema could be downregulated or the resolution of edema, in which active ion transport plays an important role, might be reduced by ketamine [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ketamine is a broadly used anaesthetic for analgosedation, especially during sepsis and cardiovascular instability. Intraoperative pulmonary edema has been reported worldwide following intramuscular or intravenous ketamine administration [ 1 – 5 ]. Pulmonary edema is the abnormal fluid accumulation in the interstitial or alveolar spaces of the lung.…”

Section: Introductionmentioning

confidence: 99%

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Ketamine Inhibits Lung Fluid Clearance through Reducing Alveolar Sodium Transport

Cui

Nie

et al. 2011

BioMed Research International

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Ketamine is a broadly used anaesthetic for analgosedation. Accumulating clinical evidence shows that ketamine causes pulmonary edema with unknown mechanisms. We measured the effects of ketamine on alveolar fluid clearance in human lung lobes ex vivo. Our results showed that intratracheal instillation of ketamine markedly decreased the reabsorption of 5% bovine serum albumin instillate. In the presence of amiloride (a specific ENaC blocker), fluid resolution was not further decreased, suggesting that ketamine could decrease amiloride-sensitive fraction of AFC associated with ENaC. Moreover, we measured the regulation of amiloride-sensitive currents by ketamine in A549 cells using whole-cell patch clamp mode. Our results suggested that ketamine decreased amiloride-sensitive Na+ currents (ENaC activity) in a dose-dependent fashion. These data demonstrate that reduction in lung ENaC activity and lung fluid clearance following administration of ketamine may be the crucial step of the pathogenesis of resultant pulmonary edema.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ketamine Inhibits Lung Fluid Clearance through Reducing Alveolar Sodium Transport

Cui

Nie

et al. 2011

BioMed Research International

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“…[ 23 ] Laryngospasm has been reported in only 0.4% of cases, 8 and has been managed with 100% positive pressure oxygen. [ 24 ]…”

Section: K Etaminementioning

confidence: 99%

Conscious sedation: Emerging trends in pediatric dentistry

et al. 2017

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Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used.

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“…Intraoperative lung edema occured after administration of intramuscular or intravenous ketamine and other anesthetics . Traditional teaching is that lung edema tends to be cardiogenic, often accompanied by left heart dysfunction, which caused back pressure across the pulmonary system, and resulted in overflow of fluid into the alveolar space.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine enhances human lung fluid clearance through improving alveolar sodium transport

Cui

Ding

Chen

et al. 2017

Fundamemntal Clinical Pharma

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Accumulating evidence shows that dexmedetomidine can attenuate lung edema with acute lung injury in experimental mouse and rat models, but the mechanisms of dexmedetomidine on human alveolar fluid transport are still unknown. We measured the effects of dexmedetomidine on alveolar fluid clearance in human lung lobes ex vivo. Moreover, we measured the regulation of transepithelial Na transport by dexmedetomidine in H441 cells by electrophysiological technique and Western blot method. Our results showed that intratracheal instillation of dexmedetomidine markedly increased the reabsorption of 5% bovine serum albumin instillate (19.8 ± 1.4%, P < 0.01 vs. Control, n = 5). Further studies suggested that dexmedetomidine increased amiloride-sensitive short-circuit currents in permeabilized H441 monolayers and whole cell amiloride-sensitive Na currents in a dose-dependent fashion. Real-time PCR and Western blot results showed that dexmedetomidine could enhance the mRNA and protein expression of α-ENaC subunit, while inhibiting the phosphorylation of ERK . These data demonstrate that dexmedetomidine could improve human lung fluid clearance and lung epithelial Na channel activity, and these effects may be mediated through the enhancement of α-ENaC expression and inhibition of ERK pathway.

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Recurrent episodes of intractable laryngospasm followed by laryngeal and pulmonary oedema during dissociative anaesthesia with intravenous ketamine

Cited by 9 publications

References 3 publications

Ketamine Inhibits Lung Fluid Clearance through Reducing Alveolar Sodium Transport

Ketamine Inhibits Lung Fluid Clearance through Reducing Alveolar Sodium Transport

Conscious sedation: Emerging trends in pediatric dentistry

Dexmedetomidine enhances human lung fluid clearance through improving alveolar sodium transport

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