Adjunctive atropine is unnecessary during ketamine sedation in children.

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 >or= 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.

Incidence and severity of recovery agitation after ketamine sedation in young adults.

PURPOSES: Psychic recovery reactions after ketamine administration are not uncommon in adults, but yet are rare in children 15 years old and younger. The nature of such reactions has not been previously described in young adults, and accordingly we wished to quantify the incidence and severity of recovery agitation after ketamine sedation in patients aged 16 to 21 years. BASIC PROCEDURES: We prospectively collected data on 26 young adults aged 16 to 21 years who received ketamine for emergency department procedures, and treating physicians rated recovery "agitation," "crying," and "unpleasant hallucinations or nightmares" each on a 100-mm visual analog scale (0 mm="none," 100 mm="worst possible"). MAIN FINDINGS: Treating physicians rated agitation and crying as entirely absent (rating 0 mm) in 25 of the 26 patients, and unpleasant hallucinations or nightmares as entirely absent (0 mm) in all 26. The single occurrences each of agitation (rating 46 mm) and crying (rating 23 mm) were not severe and resolved spontaneously without treatment. PRINCIPAL CONCLUSIONS: In this small sample of young adults we observed no serious psychic recovery reactions, mirroring the low incidence of such responses well documented with children 15 years old and younger. This supports the expansion of ketamine use to young adults aged 16 to 21 years.