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Ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD

[La kétamine utilisée pour l'anesthésie d'une ponction péricardique chez une patiente qui présente une tamponnade et une MPOC sévère]

From the Department of Anesthesiology, Queen's University, Kingston, Ontario, Canada.

Dr. Brian Milne, Department of Anesthesiology, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Phone: 613-548-7827; Fax: 613-548-1375; E-mail: milneb{at}post.queensu.ca

Purpose: 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 CO₂ retention.

Clinical features: 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 pCO₂ increased from 71.8 mmHg preoperatively to 96 mmHg intraoperatively postdrainage of 1000 mL of effusion. Hemodynamic stability and SpO₂ >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.

Conclusion: In this patient with pericardial tamponade, COPD and CO₂ retention, the advantages of ketamine included maintaining spontaneous ventilation, avoiding institution and weaning of mechanical ventilation, bronchodilation and relative preservation of the CO₂ response curve. Deleterious effects on right ventricular afterload were not observed.

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