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Post-traumatic stress disorder or emergence phenomena? A case of psychomotor agitation after procedural sedation and analgesia

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Published/Copyright: December 25, 2019
Drug Metabolism and Personalized Therapy
From the journal Drug Metabolism and Personalized Therapy Volume 34 Issue 4

Abstract

Background

Psychomotor agitation can be problematic in an overcrowded emergency department (ED) during uncontrolled procedural sedation. Although emergence phenomena have been studied, various presentations may exist.

Case presentation

During procedural sedation, a 58-year-old man was sedated with a dissociative dose of ketamine in conjunction with propofol. His shoulder dislocation was reduced successfully but eventually, an exaggerated agitation occurred resembling a post-traumatic stress disorder (PTSD) flashback of past war scenes He was controlled by physical and chemical restraint with an intramuscular injection of 0.1 mg/kg midazolam. After resolution of sedation in rather stable psychiatric conditions, he left the ED with his relatives insisting for discharge against medical advice.

Conclusions

A PTSD flashback may occur from ketamine sedation in patients with a past history of military experience and can be a manifestation of psychologic adverse effects of ketamine.

Keywords: emergence delirium; ketamine; post-traumatic stress disorder; psychomotor agitation

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Ethical approval:The research related to human use has complied with all the relevant national regulations, institutional policies and has been conducted in accordance with the tenets of the Helsinki Declaration, and it has been approved by the authors’ Institutional Review Board or equivalent committee.

References

[1] Strayer RJ, Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. Am J Emerg Med. 2008;26:985–1028.10.1016/j.ajem.2007.12.005Search in Google Scholar PubMed

[2] Schonenberg M, Reichwald U, Domes G, Badke A, Hautzinger M. Ketamine aggravates symptoms of acute stress disorder in a naturalistic sample of accident victims. J Psychopharmacol. 2008;22:493–7.10.1177/0269881107082481Search in Google Scholar PubMed

[3] Aroke EN, Crawford SL, Dungan JR. Pharmacogenetics of ketamine-induced emergence phenomena: a pilot study. Nurs Res. 2017;66:105–14.10.1097/NNR.0000000000000197Search in Google Scholar PubMed PubMed Central

[4] Kumar A, Bajaj A, Sarkar P, Grover VK. The effect of music on ketamine induced emergence phenomena. Anaesthesia. 1992;47:438–9.10.1111/j.1365-2044.1992.tb02230.xSearch in Google Scholar PubMed

[5] Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, et al. Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. Am J Psychiatry. 2010;167:640–7.10.1176/appi.ajp.2009.09081168Search in Google Scholar PubMed PubMed Central

[6] Perry EB, Cramer JA, Cho H-S, Petrakis IL, Karper LP, Genovese A, et al. Psychiatric safety of ketamine in psychopharmacology research. Psychopharmacology (Berl). 2007;192:253–60.10.1007/s00213-007-0706-2Search in Google Scholar PubMed

[7] Andolfatto G, Willman E. A prospective case series of single-syringe ketamine–propofol (Ketofol) for emergency department procedural sedation and analgesia in adults. Academic Emerg Med. 2011;18:237–45.10.1111/j.1553-2712.2011.01010.xSearch in Google Scholar PubMed

[8] Brewer CL, Davidson JR, Hereward S. Ketamine (“Ketalar”): a safer anaesthetic for ECT. Br J Psychiatry. 1972;120:679–80.10.1192/bjp.120.559.679Search in Google Scholar PubMed

[9] Wilson JT, Pokorny ME. Experiences of military CRNAs with service personnel who are emerging from general anesthesia. Aana J. 2012;80:260–5.Search in Google Scholar

[10] Treston G, Bell A, Cardwell R, Fincher G, Chand D, Cashion G. What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation? Emerg Med Australas. 2009;21:315–22.10.1111/j.1742-6723.2009.01203.xSearch in Google Scholar PubMed

[11] Nguyen S, Pak M, Paoli D, Neff DF. Emergence delirium with post-traumatic stress disorder among military veterans. Cureus. 2016;8:e921.10.7759/cureus.921Search in Google Scholar PubMed PubMed Central

[12] Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry. 2013;12:198–206.10.1002/wps.20057Search in Google Scholar PubMed PubMed Central

[13] Caddick N, Smith B, Phoenix C. Male combat veterans’ narratives of PTSD, masculinity, and health. Sociol Health Illn. 2015;37:97–111.10.1111/1467-9566.12183Search in Google Scholar PubMed

[14] Xu K, Lipsky RH. Repeated ketamine administration alters N-methyl-D-aspartic acid receptor subunit gene expression: implication of genetic vulnerability for ketamine abuse and ketamine psychosis in humans. Exp Biol Med (Maywood). 2015;240:145–55.10.1177/1535370214549531Search in Google Scholar PubMed PubMed Central

[15] Bhardwaj V, Angkaw AC, Franceschetti M, Rao R, Baker DG. Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans. Aggress Behav. 2019;45:417–26.10.1002/ab.21827Search in Google Scholar PubMed PubMed Central

[16] Liriano F, Hatten C, Schwartz TL. Ketamine as treatment for posttraumatic stress disorder: a review. Drugs Context. 2019;8:212305.10.7573/dic.212305Search in Google Scholar PubMed PubMed Central

[17] Feder A, Parides MK, Murrough JW, Perez AM, Morgan JE, Saxena S, et al. Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71:681–8.10.1001/jamapsychiatry.2014.62Search in Google Scholar PubMed

Received: 2019-09-08
Accepted: 2019-11-28
Published Online: 2019-12-25
Published in Print: 2019-12-18

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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  8. Post-traumatic stress disorder or emergence phenomena? A case of psychomotor agitation after procedural sedation and analgesia
https://doi.org/10.1515/dmpt-2019-0024
Keywords for this article
emergence delirium; ketamine; post-traumatic stress disorder; psychomotor agitation

Articles in the same Issue

  1. Original Articles
  2. Drug interactions and creatinine levels are associated with QTc prolongation in intensive care units: a prospective, observational study
  3. Pharmacogenetic relevant polymorphisms of CYP2C9, CYP2C19, CYP2D6, and CYP3A5 in Bhutanese population
  4. Short Communication
  5. Dosage of phenytoin in neurocritical patients using Bayesian algorithms: a pilot study
  6. Case Reports
  7. X-linked and autosomal dominant forms of the ichthyosis in coinheritance
  8. Post-traumatic stress disorder or emergence phenomena? A case of psychomotor agitation after procedural sedation and analgesia
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