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Adjunctive Atropine Is Unnecessary during Ketamine Sedation in Children
Author(s) -
Brown Lance,
ChristianKopp Sarah,
Sherwin Thomas S.,
Khan Aqeel,
Barcega Besh,
Denmark T. Kent,
Moynihan James A.,
Kim Grace J.,
Stewart Gail,
Green Steven M.
Publication year - 2008
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2008.00074.x
Subject(s) - hypersalivation , medicine , ketamine , anesthesia , sedation , atropine , airway , anticholinergic , airway obstruction , emergency department , psychiatry
Background: The prophylactic coadministration of atropine or other anticholinergics during dissociative sedation has historically been considered mandatory to mitigate ketamine‐associated hypersalivation. Emergency physicians (EPs) are known to omit this adjunct, so a prospective study to describe the safety profile of this practice was initiated. Objectives: To quantify the magnitude of excessive salivation, describe interventions for hypersalivation, and describe any associated airway complications. Methods: In this prospective observational study of emergency department (ED) pediatric patients receiving dissociative sedation, treating physicians rated excessive salivation on a 100‐mm visual analog scale and recorded the frequency and nature of airway complications and interventions for hypersalivation. Results: Of 1,090 ketamine sedations during the 3‐year study period, 947 (86.9%) were performed without adjunctive atropine. Treating physicians assigned the majority (92%) of these subjects salivation visual analog scale ratings of 0 mm, i.e., “none,” and only 1.3% of ratings were ≥ 50 mm. Transient airway complications occurred in 3.2%, with just one (brief desaturation) felt related to hypersalivation (incidence 0.11%, 95% confidence interval = 0.003% to 0.59%). Interventions for hypersalivation (most commonly suctioning) occurred in 4.2%, with no occurrences of assisted ventilation or intubation. Conclusions: When adjunctive atropine is omitted during ketamine sedation in children, excessive salivation is uncommon, and associated airway complications are rare. Anticholinergic prophylaxis is not routinely necessary in this setting.