title: Clinical effects of adjunctive atropine during ketamine sedation in pediatric emergency patients.
abstract: BACKGROUND
  The prophylactic coadministration of anticholinergics during dissociative sedation has been considered necessary to mitigate ketamine-associated hypersalivation. Given recent conflicting conclusions regarding adjunctive atropine, we compared the incidence of hypersalivation, degree of secretion, and related side effects with atropine or placebo as an adjunct to intravenous (IV) ketamine sedation for children.
  
  
  METHODS
  This controlled trial randomized children, 1 to 10 years old, requiring ketamine sedation in a tertiary emergency department to receive 0.01 mg/kg of atropine or placebo, along with IV ketamine (2 mg/kg). A nurse rated preprocedure and postprocedure salivation on a 100-mm visual analog scale and recorded the frequency and nature of airway complications and interventions for hypersalivation.
  
  
  RESULTS
  During 27 months, 140 patients were enrolled. Baseline characteristics did not differ between the 2 groups (P > .05). Secretion was significantly less in the atropine vs placebo group (mean visual analog scale score ± SD, 21.2 ± 13.1 [preprocedure] to 16.5 ± 9.9 [postprocedure] vs 22.4 ± 13.5 [preprocedure] to 27.0 ± 15.9 [postprocedure], respectively; P < .05). Visual analog scale scores greater than 50 were assigned to 7 (9.7%) of 72 and 1 (1.5%) of 68 patients in the placebo and atropine groups, respectively; these patients needed only medical procedures such as suction or airway repositioning. Heart rate was significantly higher in the atropine group compared with the placebo group (P < .05). There were no significant differences between the groups in terms of other adverse events.
  
  
  CONCLUSIONS
  Atropine as an adjunct to IV ketamine sedation in children significantly reduced hypersalivation, without providing a clinical benefit.
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
authors: Yu Chan
authors: YC
authors: Kye
authors: Joong Eui
authors: JE
authors: Rhee
authors: Kyuseok
authors: K
authors: Kim
authors: Taeyun
authors: T
authors: Kim
authors: You Hwan
authors: YH
authors: Jo
authors: Jin Hee
authors: JH
authors: Jeong
authors: Jin Hee
authors: JH
authors: Lee
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects / Q000627:therapeutic use*; D000778:Anesthetics, Dissociative / Q000009:adverse effects*; D001285:Atropine / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D006801:Humans; D007649:Ketamine / Q000009:adverse effects*; D022125:Lacerations / Q000601:surgery; D008297:Male; D012798:Sialorrhea / Q000139:chemically induced* / Q000517:prevention & control; D013610:Tachycardia / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D000759:Adjuvants, Anesthesia; D000778:Anesthetics, Dissociative; D007649:Ketamine; D001285:Atropine