Ketamine induction and monoamine oxidase inhibitors

A 42-year-old woman taking tranylcypromine, a monoamine oxidase (MAO) inhibitor, was hypovolemic from a ruptured ectopic pregnancy and required an emergency laparotomy. Anesthetic induction with ketamine, an agent with sympathomimetic properties, was used because of her hypovolemia, despite theoretical concerns of precipitating an adrenergic crisis. The patient's hemodynamic course remained unchanged with induction and intubation, and with further fluid and blood administration, satisfactory hemodynamic conditions were obtained. This report is believed to be the first to describe the use of ketamine in a patient taking MAO inhibitors.