Postoperative Catatonia After Fentanyl, Hydromorphone, and Ketamine Administration in a Patient Taking Sertraline: A Case Report.

IF 0.5

A&A Practice Pub Date : 2023-07-01 DOI:10.1213/XAA.0000000000001695

Laura A Ketigian, Shantanu S Kidambi

引用次数: 0

Abstract

Opioid-induced catatonia is underrecognized and poorly understood in the literature. An 81-year-old woman with chronic kidney disease stage III taking sertraline underwent surgery with general anesthesia, receiving fentanyl, hydromorphone, and ketamine. Postoperatively, she was unresponsive, rigid, and cataleptic with pinpoint pupils. Symptoms resolved with a naloxone infusion suggesting opioid-induced catatonia as the leading diagnosis. Differential diagnoses and etiologies discussed reveal a possible multifactorial catatonia mechanism involving opioids, ketamine, and serotonin. Anesthesiologists should consider these potential interactions when using opioids for management of vulnerable patients.

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芬太尼、氢吗啡酮和氯胺酮治疗舍曲林患者术后紧张症1例。

阿片类药物引起的紧张症在文献中未被充分认识和理解。一位服用舍曲林的慢性肾脏病III期的81岁妇女在全身麻醉下接受手术，接受芬太尼、氢吗啡酮和氯胺酮。术后患者无反应，僵硬，触痛，瞳孔尖状。纳洛酮输注后症状消失，提示阿片类药物引起的紧张症是主要诊断。鉴别诊断和病因讨论揭示了可能的多因素紧张症机制涉及阿片类药物，氯胺酮和血清素。麻醉师在使用阿片类药物治疗易感患者时应考虑到这些潜在的相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

A&A Practice ANESTHESIOLOGY-

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期刊介绍： A & A Case Reports, our new online journal publishing Case Reports, related Editorial Commentary, and Correspondence. Anesthesia & Analgesia 1 and Anesthesiology 2 recently announced that they were suspending publication of Case Reports. One reason is that Case Reports typically reduce the Impact Factor of a journal because they are rarely cited. Regardless of the merits of Impact Factor as a metric of journal worth, journals and their editors necessarily consider Impact Factor in strategic planning. At the same time, Case Reports are appreciated by readers for describing “real life” management of difficult or unusual cases not often encountered by practitioners. In a recent issue of Anesthesia & Analgesia, Steven Shafer1 identified many Case Reports whose publication launched productive careers dedicated to solving the puzzle posed by an unusual observation in a single patient.