Ketamine Therapy in an Adolescent Patient at 35 Weeks of Gestation With Status Asthmaticus

Abstract

The patient was a 15-year-old female gravida 1 para 0 (G1P0) presenting to the emergency department (ED) with a chief complaint of shortness of breath. Her fetus had an estimated gestational age (EGA) of 35 weeks, dated by first trimester sonography. Her past medical history was significant for asthma and suicide attempts via drug overdose. On inspection, the patient was tripoding and was given standard management protocol of nebulizer and albuterol treatments to address her asthma exacerbation. A few hours after treatment, the patient progressed to status asthmaticus and was rushed to the intensive care unit (ICU). She was intubated at that time to address her extreme respiratory acidosis. Sedation was provided with ketamine, which is also occasionally used to address status asthmaticus in refractory patients, regardless of pregnancy status. The use of ketamine in status asthmaticus is still questionable in efficacy. Given that she was under the age of 18, she was transferred to a facility more capable of handling a pediatric ICU and probable future neonatal ICU patient. The patient was transferred to Texas Childrens Hospital (TCH) via helicopter, where she was given repeat dosage of ketamine during her air travel. The patient later developed late decelerations, which required emergent primary cesarean section, at which time infant was born with Apgar scores of 1, 2, and 2. The patient was gradually weaned off the ventilator over about 1 week. She was discharged about 1 - 2 weeks later from TCH with several medications to address her asthma and prevent future attacks of this magnitude.

J Clin Gynecol Obstet. 2023;12(1):24-27
doi: https://doi.org/10.14740/jcgo855