Is atropine needed with ketamine sedation? A prospective, randomised, double blind study

Area of Science:

• Pediatric Emergency Medicine
• Pharmacology
• Anesthesiology

Background:

• Ketamine is frequently used for procedural sedation in children.
• Hypersalivation is a common side effect of ketamine sedation.
• Adjunctive medications are often used to mitigate ketamine's side effects.

Purpose of the Study:

• To evaluate the efficacy and safety of atropine as an adjunct to ketamine sedation in pediatric patients undergoing painful procedures.
• To compare the incidence of hypersalivation, side effects, patient/parent satisfaction, and procedural success between atropine and placebo groups.

Main Methods:

• A randomized controlled trial was conducted in a tertiary emergency department.
• 83 children (1-16 years) received either 0.01 mg/kg atropine or placebo, along with 4 mg/kg intramuscular ketamine.
• Data collected included sedation scores, side effects, and patient/parent satisfaction.

Main Results:

• Atropine significantly reduced hypersalivation (11.4% vs 30.8%) and vomiting (9.1% vs 25.6%) compared to placebo.
• A higher incidence of transient rash was observed in the atropine group (22.7% vs 5.1%).
• No serious adverse events were reported in either group.

Conclusions:

• Atropine is effective in reducing hypersalivation and vomiting associated with ketamine procedural sedation in children.
• While atropine increases the risk of transient rash, it is generally well-tolerated and safe.
• Atropine can be considered a beneficial adjunct to ketamine sedation for pediatric procedures.