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Possible gabapentin and ketamine interaction causing prolonged central nervous system depression during post-operative recovery following cervical laminoplasty: a case report.

Elyassi AR, Long RP, Bejnarowicz RP, Schoneboom BA - J Med Case Rep (2011)

Bottom Line: All organic causes were excluded, with the exception of prolonged central nervous system depression from a gabapentin/ketamine drug interaction.A new onset conversion disorder could also not be excluded.Although this case by itself is not enough evidence to substantiate a true adverse reaction between gabapentin and ketamine, it is enough to warrant further investigation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA. aelyassi@gmail.com.

ABSTRACT

Introduction: The drugs gabapentin and ketamine are used frequently in the peri-operative setting. There is poor documentation whether or not gabapentin and ketamine interact to cause prolonged depression of the central nervous system.

Case presentation: The following is a case report in which a patient, a 58-year-old African-American man, with a history of post-traumatic stress disorder and chronic pain underwent a cervical laminoplasty procedure. The patient presented post-operatively in a dissociative state with paralysis, anarthria and preservation of consciousness. All organic causes were excluded, with the exception of prolonged central nervous system depression from a gabapentin/ketamine drug interaction. A new onset conversion disorder could also not be excluded.

Conclusion: Although this case by itself is not enough evidence to substantiate a true adverse reaction between gabapentin and ketamine, it is enough to warrant further investigation.

No MeSH data available.


Related in: MedlinePlus

Post-operative axial CT of head showing no intracranial pathology.
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Figure 2: Post-operative axial CT of head showing no intracranial pathology.

Mentions: In the PACU, our patient was not moving his upper or lower extremities and his verbal response consisted of "aha" or blowing through pursed lips. His pupils remained equal and reactive to light. When asked to respond by blinking, our patient would blink uncontrollably. His extremities were flaccid and areflexic. Our patient's vitals remained stable and oxygen saturation was 100%. His arterial blood gas was obtained and was normal, except for partial carbon dioxide (pCO2) of 50 mmHg. No electrolyte abnormalities were detected. A urine analysis was within normal limits, along with glucose, ammonia, and lactate levels. Motor evoke potentials were rechecked and remained unchanged from pre-operative values. It was then decided to obtain a CT of the head and neck region (Figures 2 and 3).


Possible gabapentin and ketamine interaction causing prolonged central nervous system depression during post-operative recovery following cervical laminoplasty: a case report.

Elyassi AR, Long RP, Bejnarowicz RP, Schoneboom BA - J Med Case Rep (2011)

Post-operative axial CT of head showing no intracranial pathology.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104365&req=5

Figure 2: Post-operative axial CT of head showing no intracranial pathology.
Mentions: In the PACU, our patient was not moving his upper or lower extremities and his verbal response consisted of "aha" or blowing through pursed lips. His pupils remained equal and reactive to light. When asked to respond by blinking, our patient would blink uncontrollably. His extremities were flaccid and areflexic. Our patient's vitals remained stable and oxygen saturation was 100%. His arterial blood gas was obtained and was normal, except for partial carbon dioxide (pCO2) of 50 mmHg. No electrolyte abnormalities were detected. A urine analysis was within normal limits, along with glucose, ammonia, and lactate levels. Motor evoke potentials were rechecked and remained unchanged from pre-operative values. It was then decided to obtain a CT of the head and neck region (Figures 2 and 3).

Bottom Line: All organic causes were excluded, with the exception of prolonged central nervous system depression from a gabapentin/ketamine drug interaction.A new onset conversion disorder could also not be excluded.Although this case by itself is not enough evidence to substantiate a true adverse reaction between gabapentin and ketamine, it is enough to warrant further investigation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Road, Honolulu, HI 96859-5000, USA. aelyassi@gmail.com.

ABSTRACT

Introduction: The drugs gabapentin and ketamine are used frequently in the peri-operative setting. There is poor documentation whether or not gabapentin and ketamine interact to cause prolonged depression of the central nervous system.

Case presentation: The following is a case report in which a patient, a 58-year-old African-American man, with a history of post-traumatic stress disorder and chronic pain underwent a cervical laminoplasty procedure. The patient presented post-operatively in a dissociative state with paralysis, anarthria and preservation of consciousness. All organic causes were excluded, with the exception of prolonged central nervous system depression from a gabapentin/ketamine drug interaction. A new onset conversion disorder could also not be excluded.

Conclusion: Although this case by itself is not enough evidence to substantiate a true adverse reaction between gabapentin and ketamine, it is enough to warrant further investigation.

No MeSH data available.


Related in: MedlinePlus