There is an increased incidence of emergence delirium with ketamine in all of the following condition except:-
**Core Concept**
Ketamine, an NMDA receptor antagonist, is a widely used anesthetic agent. However, its use is associated with emergence delirium, a condition characterized by confusion, agitation, and hallucinations. The underlying principle being tested here is the identification of conditions that increase the risk of emergence delirium with ketamine.
**Why the Correct Answer is Right**
Emergence delirium is more likely to occur with ketamine in patients with a history of psychiatric disorders, particularly those with a history of schizophrenia or bipolar disorder. This is because ketamine can exacerbate psychotic symptoms and increase the risk of hallucinations and delirium. The NMDA receptor antagonism by ketamine may also contribute to its psychotogenic effects.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because patients with a history of anxiety disorders do not have a significantly increased risk of emergence delirium with ketamine. While anxiety can be a concern during anesthesia, it is not a major risk factor for emergence delirium.
**Option B:** This option is incorrect because patients with a history of substance abuse do not have a significantly increased risk of emergence delirium with ketamine. However, substance abuse can increase the risk of other complications during anesthesia.
**Option C:** This option is incorrect because patients with a history of traumatic brain injury do not have a significantly increased risk of emergence delirium with ketamine. However, traumatic brain injury can increase the risk of other complications during anesthesia.
**Clinical Pearl / High-Yield Fact**
Remember that patients with a history of psychiatric disorders, particularly schizophrenia or bipolar disorder, are at increased risk of emergence delirium with ketamine. This is a critical consideration when choosing anesthetic agents for patients with a psychiatric history.
**Correct Answer: A.**