Expert: Dr Ian Jackson - please note UK based - 8/18/2007

Question
My son broke his arm and they used conscious sedation (I believe it was Ketamine). He recently underwent testing where they used chlorohydrate. My question is three-fold. He is 5 years old and both times he came out from under these meds in a state of  paranoid & crazed violence; both physically and verbally. Often, he didn't recognize me as his mother, at other times he did. I do not want these used on him EVER again. I'm having a hard time locating the drug family these belong to so that I can unequivocably state what sedation I do not want used on him. Can you help me?
   Second, a little over a month after the first CS, he had a Grand Mal Seizure. He has had two more since and is currently on Trileptal as a result. I'm wondering if the CS could have caused this as he's never had seizures before?
   Last, they're going to put him completely under (IV) for their next attempt at an MRI & EEG since the Chlorohydrate didn't work. Do I need to be cognicent of the type of anesthesia they use on him due to the Trileptal he takes? Thank you!

Answer
Hi there
I am really sorry to hear about the problems your son has experienced after his sedation. Ketamine is a phencyclidine and is used quite extensively especially in children. In my experience when used regularly e.g. in children undergoing radiotherapy it was very safe and seemed to have few after effects. However it is well recognised to cause vivid dreams (in colour) and a degree of disturbance during the emergence phase in adults. This can also happen in children.
Chlorohydrate is unrelated and belongs to a totally different group of drugs so there is no pattern there. The pattern does seem to be his reaction to 'sedatives' and some people react quite unusually to sedatives and indeed anaesthetics as a whole.
I seriously doubt that the conscious sedation led to his seizure problem as it is difficult to see a mechanism for this - however I learned a long time ago in medicine never to say never. I hope that the scan and EEG will help with his diagnosis.
As to the final question the answer is no - you need to provide the information to the anaesthetist about the drugs he is on and the reactions he has had in the past to the other drugs. Then the anaesthetist should explain how he/she is going to look after your son.
All the best
Dr Ian Jackson