KETAMINE-INDUCED CATALEPSY DURING ADULT SEDATION IN THE EMERGENCY DEPARTMENT

Background: Ketamine continues to rise in popularity for procedural sedation in the Emergency Department (ED) for both adult and pediatric patients. The medication has a good safety profile and is well tolerated in the majority of patients. However, the Emergency Physician should be aware of the full range of side-effects that may be encountered, so as to best anticipate and prepare for potential complications. Objectives: We describe two cases of catalepsy (muscle hypertonia with dissociation) in patients undergoing sedation with ketamine. Case Report: In the first case, a patient presented to the ED after a prehospital awake nasal intubation for an exacerbation of chronic obstructive pulmonary disease. After sedation with ketamine, he was extubated and transitioned to bi-level positive pressure ventilation. Shortly after receiving ketamine, he exhibited severe muscular hypertonia of the upper extremities with facial grimacing. A second patient underwent ketamine sedation for reduction of a shoulder dislocation. After medication administration, he exhibited full body muscular hypertonicity, interfering briefly with the procedure. In both patients, catalepsy resolved spontaneously. Conclusions: Ketamine-induced catalepsy is a self-limited side-effect that has the potential to interfere with procedures performed under sedation. (c) 2013 Elsevier Inc.