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Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation
Tammy T Nguyen1, Bethany Baker2, Jeffrey D Ferguson3
1Department of Pharmacy, Virginia Commonwealth University Medical Center, Richmond, Virginia; Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia.
The Journal of Emergency Medicine
|October 23, 2016
Summary
This case report details a rare allergic reaction to ketamine (anesthetic) during procedural sedation. Emergency physicians should monitor for potential adverse effects like skin rashes, even with ketamine monotherapy.
Area of Science:
- Anesthesiology
- Emergency Medicine
- Pharmacology
Background:
- Ketamine, a cyclohexamine derivative, functions as a noncompetitive N-methyl D-aspartate receptor antagonist.
- National clinical policy endorses ketamine for procedural sedation.
- The immunogenic potential of ketamine remains incompletely understood.
Observation:
- A 16-year-old male experienced an allergic reaction post-intravenous ketamine administration for procedural sedation.
- Within minutes, the patient developed a widespread morbilliform, erythematous rash.
- The rash resolved following treatment with intravenous diphenhydramine.
Findings:
- This is the first reported case of an allergic reaction to ketamine used as monotherapy for procedural sedation in an emergency department setting.
- The reaction is likely attributable to ketamine-induced histamine release, a phenomenon observed in vitro.
- The patient presented with a generalized erythematous rash, indicative of a hypersensitivity response.
Implications:
- Emergency physicians must be aware of ketamine's potential to cause allergic reactions, including skin manifestations.
- Severe anaphylactic reactions may necessitate advanced airway and hemodynamic support.
- Recognition of this adverse effect is crucial for safe ketamine administration in procedural sedation.
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