Tachycardia ketamine

Other reported side effects include vomiting, salivation, lacrimation, shivering, skin rash, and an interaction with thyroid preparations that may lead to hypertension and tachycardia. Ketamine also may raise intracranial pressure and elevate pulmonary vascular resistance, especially in children with trauma or congenital heart disease. Increases in intraocular pressure also may occur, and vigilance is required if ketamine is used in ocular surgery. 

THYROID HORMONES ANAESTHETICS -GENERAL-KETAMINE Cases of tachycardia and hypertension when ketamine was given to patients on thyroxine this required treatment with propanolol Uncertain Monitor PR and BP closely... 

Tachycardia and hypertension are common after anesthetic induction with ketamine, although the hypertension can be limited by the addition of diazepam (10). Nodal dysrhythmias can also occur (11). Because of possible... 

Marked hypertension and tachycardia occurred in two patients taking levothyroxine when they were given ketamine. 

Two patients taking levothyroxine developed severe hypertension (240/140 and 210/130 mmHg, respectively) and tachycardia (190 and 150 bpm) when they were given ketamine. Both were eflectively treated with 1 mg of intravenous propranolol. It was not clear whether this was an interaction or simply a particularly exaggerated response to ketamine, but care is clearly needed if ketamine is given to patients taking thyroid replacement. 

Cardiac arrhythmias can develop during the concurrent use of halothane and aminophylline but this seems less likely with isoflu-rane. One report attributes seizures to an interaction between ketamine and aminophylline. Supraventricular tachycardia occurred in a patient taking aminophylline when pancuronium was given. Isolated cases suggest that the effects of pancuronium, but not vecuronium, can be opposed by aminophylline. 

Over a period of 9 years, tachycardia and extensor-type seizures were observed in 4 patients taking theophylline or aminophylline, who were initially anaesthetised with ketamine, and later with halothane or enllurane." Based on subsequent study in mice, the authors attributed the seizures to an interaction between ketamine and theophylline or aminophylline, and they suggest that the combination should perhaps be avoided in some, or antiseizure premedication be given to patients at risk. However, these cases come from one isolated report. Note that, in mice, ketamine had no effect on aminophylline-induced seizures. ... 

Propofol In a randomized study in 60 children who underwent interventional radiology and were allocated to propofol 0.5 mg/kg - -fentanyl 1 microgram/kg + ketamine 0.5 mg/kg ( = 30) or propofol 0.5 mg/kg - - fentanyl 1 microgram/kg + saline 0.9% ( = 30) intravenously, there was oxygen desaturation in three of those who received ketamine and nine of those who did not [80 ]. Those who received ketamine also had agitation n = 2) and tachycardia ( = 1), which did not occur in the other group. Nystagmus was also a common adverse reaction (19 cases versus... 

A further study reviewed 18 patients over a 3 year period with acute agitation and psychiatric illness requiring aero medical retrieval imder the mental health act [5(T]. Intravenous ketamine for sedation of patients was used as an alternative to a general anaesthetic and intubation. Patients were given up to two bolus doses of 0.5-1 mg/kg followed by an infusion of 1-1.5 mg/kg/hr. Only mild adverse events occurred with four patients having hypertension and tachycardia all of which spontaneously resolved. One patient vomited but there were no incidences of aspiration and no airway intervention was required. Thus ketamine could be considered as a safe alternative to general anaesthetic in this study population. 

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