title: Hypertension and pulmonary oedema associated with ketamine administration in a patient with a history of substance abuse.
abstract: Cocaine use, frequently associated with other substance abuse, is becoming more common in the pregnant patient. These patients are more likely to experience peripartum complications. A case of hypertension and pulmonary oedema in such a patient, possibly triggered by ketamine, is reported. A tumultuous course in the intensive care unit was resolved when the patient's hypertension and sympathetic reactivity were successfully treated with barbiturates. A number of factors supported a diagnosis of barbiturate withdrawal in this patient, its onset also was related temporally to ketamine administration. Hypertension should be considered a sign of acute barbiturate withdrawal. If a history of cocaine use, particularly crack cocaine, is elicited, one should suspect multiple substance abuse and be especially cautious when administering ketamine.
authors.affiliation: Ohio State University, College of Medicine, Department of Anesthesiology, Columbus 43210.
authors.forename: J L
authors.initials: JL
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000771:Anesthesia, Intravenous; D000775:Anesthesia, Spinal; D016578:Crack Cocaine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000188:drug therapy; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage; D010634:Phenobarbital / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000150:complications*; D013610:Tachycardia / Q000139:chemically induced
chemical_list: D016578:Crack Cocaine; D007649:Ketamine; D008012:Lidocaine; D010634:Phenobarbital