Friday, July 30, 2010


Ketamine is an anesthetic medicine that we use everyday for procedures on kids and adults. Typically a patient who gets ketamine continues to be asleep for about 30 minutes to 1 hr after they received the medicine. Some patients don't respond initially to the Ketamine and require another dose in order to do the procedure. Recently I had a kid who responded a little too well.
He presented with a swollen L leg that on exam was infected. He needed an incision and drainage to get the pus out, but in order to do that I needed to give him Ketamine. So I gave him a shot, like I do every day, multiple times a day. He went to sleep pretty easily, and I was able to put a needle in to try and find the pus. When I was done, I wrote up his admission orders and expected him to go to the ward. 4 hours later I get a call from the nurse in the ER saying the pt is still in the ER. I asked her why, and she said he hasn't woken up from Ketamine. What do you mean, that was 4 hours ago?
So I go and check him and everything is fine, except he is still sleeping. I call Jim to see if he knows of anything I could give to reverse it, he didn't, but reassured me the kid should be ok. I asked Bill later when he came home, and he said the same thing. The next morning, now 12+ hours out, I went to check on the kid, and he was still sleeping. Definitely not normal. Jim and Bill think maybe they had seen someone asleep for 2 or 3 hrs, but 12, never. We keep watching him as everything else is ok. 24 hrs - awake some, but not completely, 36 hrs - eating a little, but falls asleep pretty quickly, 60 hrs - awake, but not a normal 3-4 yr old. What happened?
I have no idea, other than for some reason his little body isn't metabolizing the Ketamine like everyone else's does and he stayed under anesthesia for a very long time. Thankfully, he continues to move in the right direction everyday and we pray he recovers completely from this reaction that he had.