Near-Death Experience During Emergency Ketamine Use: A Case Report.

PURPOSE: Survivors from acute life-threatening conditions occasionally report various alterations in subjective experiences, ranging from visual perceptual changes to multi-faceted phenomena that can be categorized as near-death experiences (NDEs). We report an NDE in a 73-year-old woman with an acute exacerbation of chronic obstructive pulmonary disease, requiring emergency intubation and mechanical ventilation for acute respiratory failure. METHOD: The patient suffered from profound hypoxia and hypercapnia with uncompensated respiratory acidosis. Prehospital anesthesia was induced with an intravenous bolus of 500 mg of ketamine administered over 60 s, corresponding to 7 mg/kg of adjusted body weight. The patient eventually recovered and was weaned from ventilator after 24 h. Semi-structured interviews, including several standardized scales assessing potential subjective experience and post-event impact, were conducted at 2 weeks and 2 months post-event. FINDING: Findings revealed a vivid NDE (i.e., meeting the NDE Content scale criteria, with total scores of 34/80 and 32/80 at the first and second interviews, respectively), notably characterized by feelings of peacefulness and well-being, encounters with entities, and the perception of a bright light. Over time, the narrative evolved, with some elements no longer recalled at follow-up, while the patient reported a positive psychological transformation, including improved mood and increased empathy. CONCLUSION: This case, set within its medical and pharmacological context, provides a unique opportunity to study NDEs and their precipitating context. The reported transformations underscore the importance of recognizing NDEs for their possible long-term effects on patients and relevance to medical practice.