Is ketamine a safe anesthetic for percutaneous liver biopsy in a liver transplant recipient immunosuppressed with cyclosporine?
A 6-yr-old male patient underwent live related left lateral segment liver transplant for cryptogenic cirrhosis with portal hypertension. One month after the liver transplant the patient had an isolated liver transaminases increase. He was posted for percutaneous liver biopsy for suspected graft rejection under general anesthesia. The patient was administered ketamine 7 mg/kg along with glycopyrrolate 0.01 mg/kg IM in the preoperative area. He developed generalized tonic clonic seizures just before the biopsy and was treated with IV midazolam 1 mg and thiopental 60 mg. Percutaneous liver biopsy was obtained once the convulsions subsided. Both ketamine and cyclosporine have been implicated as having proconvulsant properties and may have been responsible for the seizures in our patient. Our experience prompted us to suggest that ketamine in a patient immunosuppressed with cyclosporine may not be safe and that alternative anesthetics may need to be considered for such procedures.
Agarwal
Anil
A
Department of Anesthesia and *Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Raza
Mehdi
M
Dhiraaj
Sanjay
S
Saxena
Rajan
R
Singh
Prabhat K
PK
Pandey
Ravindra
R
D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D001706:Biopsy; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects*; D004569:Electroencephalography; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007649:Ketamine / Q000009:adverse effects*; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D012640:Seizures / Q000139:chemically induced*
D000778:Anesthetics, Dissociative; D007166:Immunosuppressive Agents; D007649:Ketamine; D016572:Cyclosporine