Long-lasting neurocognitive disorders: a case report of previously undescribed adverse effects after ketamine sedation and analgesia in a pediatric patient.

Autor:	Machado-Ferraro KM; Post-Graduate Program in Pharmacology and Biochemistry, Federal University of Pará, Belém, Pará, Brazil.; Hospital Fundação Santa Casa de Misericórdia do Pará (FSCMP), Unidade Materno Infantil Dr. Almir Gabriel, Belém, Pará, Brazil.; Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Health Science Institute, Federal University of Pará, Belém, Pará, Brazil., Soriano-de-Mello DS; University Center of Pará-CESUPA, Belém, Pará, Brazil., de Moura IP; University Center of Pará-CESUPA, Belém, Pará, Brazil., da Silveira CCSM; Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Health Science Institute, Federal University of Pará, Belém, Pará, Brazil., de Farias ECF; Hospital Fundação Santa Casa de Misericórdia do Pará (FSCMP), Unidade Materno Infantil Dr. Almir Gabriel, Belém, Pará, Brazil., Maia MLF; Post-Graduate Program in Pharmacology and Biochemistry, Federal University of Pará, Belém, Pará, Brazil.; Hospital Fundação Santa Casa de Misericórdia do Pará (FSCMP), Unidade Materno Infantil Dr. Almir Gabriel, Belém, Pará, Brazil., de Sales SCD; Hospital Fundação Santa Casa de Misericórdia do Pará (FSCMP), Unidade Materno Infantil Dr. Almir Gabriel, Belém, Pará, Brazil., Carvalho AEV; University Center of Pará-CESUPA, Belém, Pará, Brazil., Magno IMN; University Center of Pará-CESUPA, Belém, Pará, Brazil., Fontes-Júnior EA; Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Health Science Institute, Federal University of Pará, Belém, Pará, Brazil., Maia CSF; Post-Graduate Program in Pharmacology and Biochemistry, Federal University of Pará, Belém, Pará, Brazil.; Laboratory of Pharmacology of Inflammation and Behavior, Faculty of Pharmacy, Health Science Institute, Federal University of Pará, Belém, Pará, Brazil.
Jazyk:	angličtina
Zdroj:	Annals of translational medicine [Ann Transl Med] 2022 Jan; Vol. 10 (2), pp. 113.
DOI:	10.21037/atm-21-2292
Abstrakt:	This case report describes the long-term behavioral and cognitive alterations in a critically ill pediatric patient submitted to a ketamine sedation and analgesia protocol for 7 consecutive days in a pediatric intensive care unit. The infant exhibited withdrawal syndrome in the early withdrawal period, as measured using the Withdrawal Assessment Tool-1 (WAT-1). In the days following ketamine withdrawal, behavioral, motor, and cognitive impairment was observed, even after hospital discharge. At 20 days after admission to hospital, the infant still displayed language deficits compatible with the at-risk category for the appropriate age group on the development assessment (Denver-II Developmental Screening Test). The infant's mother reported that these impairments were not present before ketamine sedation. We therefore suggest that prolonged ketamine use may have contributed to the long-lasting behavioral and cognitive impairments observed in the critically ill infant. These adverse effects may be attributable to ketamine's pharmacological mechanism of action, by which the N-methyl-D-aspartate receptor-the central nervous system excitatory receptor responsible for memory and learning domains-is blockaded, disrupting long-term potentiation events. Our case highlights the need for clinical evaluation of ketamine agents and their associated risks in intensive care units to better clarify appropriate sedative and analgesic agents during neurodevelopmental periods of life. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view//10.21037/atm-21-2292/coif). The authors have no conflicts of interest to declare. (2022 Annals of Translational Medicine. All rights reserved.)
Databáze:	MEDLINE
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