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Ok, i have a clinical question for the SRNA's and CRNA's. The situation went like this. A patient came in to endoscopy with extreme anxiety and complaining of nausea. He had been NPO for 12 hours, the only thing he had had for 24 hours was his prep for colonoscopy. He received 2mg versed preop then 2mg more in the room, he had received 10mg of versed the previous week for EGD so it was recommended he get more than we usually use which is 2mg. He had a poor airway and was obese. To avoid using too much propofol he was given 20mg of Ketamine after his 4mg of versed and about 50mg of propofol. During the procedure he continued to move and received boluses of propofol totalling 200mg about 15-20minutes into the procedure. Then he started to make a gurgling sound and it was observed he was starting to cough. He was immediately suctioned and it appeared he vomitted. He was then bagged and suctioned until his sats become adequate and he woke up. Now my question is, could the ketamine have caused increased secretions enough to make him cough and vomit? This was an extremely nerve racking experience so it would be nice to hear some thoughts from experienced folks. Thanks.
the crna i was with likes ketamine and so we used a little. i guess i didn't describe the scenario very well. the patient only recieved small doses of propofol after the ketamine and it was deep sedation. the patient was an adult and was not morbidly obese, just overweight. he received preop zofran. i understand not wanting to go to a GA for an endo case and the crna i was with did not think it was anything done by anesthesia that caused the problem. i was just wondering about small doses of ketamine and it's ability to cause enough irritation to result in vomitting. i appreciate the responses. i'm still learning.
In our facility, when anesthesia is asked to assist, then there is something about the patient that either dictates a more experienced provider (co-morbidity) or the patient is extremely anxious and requires a deep sedation that the GI department does not feel comfortable (nor should they) performing.
Mike
mwbeah
430 Posts
I totally agree, you know as well as I that as long as it is used in 0.5 to 1.0 mg/kg the patients do not need long at all to recover. Even with higher doses, typically (with my experience) they don't need more that 35-40 minutes tops (doses may be higher in non-GI cases).
Mike