title: Adjunctive atropine is unnecessary during ketamine sedation in children.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors: Division of Pediatric Emergency Medicine, Loma Linda University Medical Center & Children's Hospital, Loma Linda, CA, USA.
authors: Lance
authors: L
authors: Brown
authors: Sarah
authors: S
authors: Christian-Kopp
authors: Thomas S
authors: TS
authors: Sherwin
authors: Aqeel
authors: A
authors: Khan
authors: Besh
authors: B
authors: Barcega
authors: T Kent
authors: TK
authors: Denmark
authors: James A
authors: JA
authors: Moynihan
authors: Grace J
authors: GJ
authors: Kim
authors: Gail
authors: G
authors: Stewart
authors: Steven M
authors: SM
authors: Green
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects; D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000008:administration & dosage* / Q000009:adverse effects; D001285:Atropine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D012798:Sialorrhea / Q000139:chemically induced
chemical_list: D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D007649:Ketamine; D001285:Atropine