title: Ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD.
abstract: OBJECTIVE
  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 CO(2) retention.
  
  
  METHODS
  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 pCO(2) increased from 71.8 mmHg preoperatively to 96 mmHg intraoperatively postdrainage of 1000 mL of effusion. Hemodynamic stability and SpO(2) >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.
  
  
  CONCLUSIONS
  In this patient with pericardial tamponade, COPD and CO(2) retention, the advantages of ketamine included maintaining spontaneous ventilation, avoiding institution and weaning of mechanical ventilation, bronchodilation and relative preservation of the CO(2) response curve. Deleterious effects on right ventricular afterload were not observed.
authors.affiliation: Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Aye
authors.forename: Brian
authors.initials: B
authors.lastname: Milne
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D002245:Carbon Dioxide / Q000097:blood; D002305:Cardiac Tamponade / Q000601:surgery*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000494:pharmacology*; D010491:Pericardial Window Techniques; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D002245:Carbon Dioxide; D007649:Ketamine