A case of withdrawal syndrome treated with ketamine

Abstract

A patient who required mechanical ventilation because of Guillain–Barré syndrome that developed abroad was transferred to our hospital via a medical jet. On admission, the patient received continuous intravenous (IV) infusions of midazolam (0.9 mg/kg/hr), dexmedetomidine (1.9 μg/kg/hr), propofol (1.3 mg/kg/hr), and remifentanil (0.27 μg/kg/min). The patient was also given an enteral administration of pregabalin (300 mg/day), quetiapine (300 mg/day), and trazodone (150 mg/day). After discontinuing the administration of midazolam, dexmedetomidine, and remifentanil, the patient developed severe body movements and tachypnea, which prompted the admission of the patient to the ICU. After IV administration of ketamine (50 mg), continuous ketamine administrations (0.53 mg/kg/hr) were initiated, which resulted in adequate sedation. Suspecting withdrawal syndrome, we then reinitiated infusions of midazolam, dexmedetomidine, and fentanyl. The dose for each drug was then tapered before being discontinued. The patient was discharged to the general ward after 15 days in the ICU and was then transferred to a rehabilitation center after 47 days of hospitalization.