Abstract
Purpose
To describe the use and concerns of ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe chronic obstructive pulmonary disease (COPD) with CO2 retention.
Clinical features
A 73-yr-old woman with long-standing COPD and cor pulmonale admitted with pericardial effusion and tamponade had surgery for a pericardial window receiving a total of ketamine 450 mg iv. Arterial pCO2 increased from 71.8 mmHg preoperatively to 96 mmHg intraoperatively postdrainage of 1000 mL of effusion. Hemodynamic stability and SpO2 > 93% were maintained. Intubation was avoided and concerns of increased pulmonary vascular resistance and potential for right ventricular failure in an already compromised right ventricle were not observed clinically.
Conclusion
In this patient with pericardial tamponade, COPD and CO2 retention, the advantages of ketamine included maintaining spontaneous ventilation, avoiding institution and weaning of mechanical ventilation, bronchodilation and relative preservation of the CO2 response curve. Deleterious effects on right ventricular afterload were not observed.
Résumé
Objectif
Décrire l’utilisation de l’anesthésie avec kétamine et les craintes qu’elle suscite dans le cas d’une ponction péricardique chez une patiente qui présente une tamponnade et une maladie pulmonaire obstructive chronique (MPOC) sévère avec rétention de CO2.
Éléments cliniques
Une femme de 73 ans atteinte d’une MPOC de longue date et d’un cœur pulmonaire et présentant un épanchement péricardique et une tamponnade, a subi une ponction péricardique et a reçu 450 mg iv de kétamine. La pCO2 artérielle a augmenté de 71,8 mmHg, avant l’opération, à 96 mmHg pendant l’opération, le postdrainage de 1 000 mL de liquide. La stabilité hémodynamique et la SpO2 ont été maintenues > 93 %. On a évité l’intubation et les craintes d’une augmentation de la résistance vasculaire pulmonaire et de la possibilité d’une défaillance ventriculaire droite dans un ventricule déjà altéré ne se sont pas matérialisées.
Conclusion
La kétamine utilisée dans le présent cas de tamponnade cardiaque, MPOC et rétention de CO2 a permis le maintien de la ventilation spontanée, l’absence d’hospitalisation et le sevrage de la ventilation mécanique, la bronchodilatation et la préservation relative de la courbe de réponse du CO2. Nous n’avons pas noté d’effet nocif sur la postcharge ventriculaire droite.
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References
Lake CL. Anesthesia and pericardial disease. Anesth Analg 1983; 62: 431–43.
Stanley TH, Weidauer HE. Anesthesia for the patient with cardiac tamponade. Anesth Analg 1973; 52: 110–3.
Kaplan JA, Bland JW Jr, Dunbar RW. The perioperative management of pericardial tamponade. South Med J 1976; 69: 417–9.
Spotoft H, Korshin JD, Sørensen MB, Skovsted P. The cardiovascular effects of ketamine used for induction of anaesthesia in patients with valvular heart disease. Can Anaesth Soc J 1979; 26: 463–7.
Breen PH, MacVay MA. Pericardial tamponade: a case for awake endotracheal intubation (Letter). Anesth Analg 1996; 83: 658.
Stoelting R. Nonbarbiturate induction drugs.In: Stoelting R (Ed.). Pharmacology & Physiology in Anesthetic Practice, 3rd ed., Philadelphia, Pennsylvania: Lippincott-Raven, 1999: 140–57.
Rees DI, Gaines IIIGY. One-lung anesthesia—a comparison of pulmonary gas exchange during anesthesia with ketamine or enflurane. Anesth Analg 1984; 63: 521–5.
Bålfors E, Häggmark S, Nyhman H, Rydvall A, Reiz S. Droperidol inhibits the effects of intravenous ketamine on central hemodynamics and myocardial oxygen consumption in patients with generalized atherosclerotic disease. Anesth Analg 1983; 62: 193–7.
Sarma VJ. Use of ketamine in acute severe asthma. Acta Anaesthesiol Scand 1992; 36: 106–7.
Soliman MG, Brindle GF, Kuster G. Response to hypercapnia under ketamine anaesthesia. Can Anaesth Soc J 1975; 22: 486–94.
Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth 1989; 36: 186–97.
Bourke DL, Malit LA, Smith TC. Respiratory interactions of ketamine and morphine. Anesthesiology 1987; 66: 153–6.
Möller CT, Schoonbee CG, Rosendorff C. Haemodynamics of cardiac tamponade during various modes of ventilation. Br J Anaesth 1979; 51: 409–14.
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Aye, T., Milne, B. Ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD. Can J Anesth 49, 283–286 (2002). https://doi.org/10.1007/BF03020528
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DOI: https://doi.org/10.1007/BF03020528