Is atropine needed with ketamine sedation? A prospective, randomised, double blind study
Open accessAbstract
OBJECTIVE: To compare atropine with placebo as an adjunct to ketamine sedation in children undergoing minor painful procedures. Outcome measures included hypersalivation, side effect profile, parental/patient satisfaction, and procedural success rate. METHODS: Children aged between 1 and 16 years of age requiring ketamine procedural sedation in a tertiary emergency department were randomised to receive 0.01 mg/kg of atropine or placebo. All received 4 mg/kg of intramuscular ketamine. Tolerance and sedation scores were recorded throughout the procedure. Side effects were recorded from the start of sedation until discharge. Parental and patient satisfaction scores were obtained at discharge and three to five days after the procedure, with the opportunity to report side effects encountered at home. RESULTS: A total of 83 patients aged 13 months to 14.5 years (median age 3.4 years) were enrolled over a 16 month period. Hypersalivation occurred in 11.4% of patients given atropine compared with 30.8% given placebo (odds ratio (OR) 0.29, 95% confidence interval (CI) 0.09 to 0.91). A transient rash was observed in 22.7% of the atropine group compared with 5.1% of the placebo group (OR 5.44, 95% CI 1.11 to 26.6). Vomiting during recovery occurred in 9.1% of atropine patients compared with 25.6% of placebo patients (OR 0.29, 95% CI 0.09 to 1.02). There was a trend towards better tolerance in the placebo group. No patient experienced serious side effects. CONCLUSION: Ketamine sedation was successful and well tolerated in all cases. The use of atropine as an adjunct for intramuscular ketamine sedation in children significantly reduces hypersalivation and may lower the incidence of post-procedural vomiting. Atropine is associated with a higher incidence of a transient rash. No serious adverse events were noted.
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NMDA-receptor antagonists such as MK801, ketamine, and phencyclidine cause symptoms similar to anti-NMDA-receptor encephalitis, including psychotic behaviour, signs of involvement of dopaminergic pathways, and autonomic dysfunction.
“Consistent with this antibody-induced decrease in the numbers of NMDA receptors, several NMDA-receptor antagonists such as MK801, ketamine, and phencyclidine cause symptoms similar to anti-NMDA-receptor encephalitis, including psychotic behaviour,21,22 signs of involvement of dopaminergic pathways (rigidity, dystonia, orofacial movements, tremor)22–25 and autonomic dysfunction (cardiac dysrhythmia”
From Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies (2008) · cites this paper as [27]
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- Authors
- Heinz, P.
- Affiliations
- Cambridge University Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Heinz, P
- Venue
- Emergency Medicine Journal
- Publisher
- BMJ
- Published
- 2006-03-01
- Volume
- 23
- Issue
- 3
- Pages
- 206-209
- ISSN
- 1351-0622 (ISSN-L)
- 1472-0205
- 1472-0213
- PMC
- PMC2464444
- OpenAlex
- W2063941966
- Cited by
- 113
- References
- 18
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 3 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 4 · 2014: 8 · 2013: 8 · 2012: 9
- FWCI
- 7.85
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Emergency Medicine Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- ketamine sedation, atropine, procedural sedation, children, hypersalivation, sedation side effects, parental satisfaction, patient satisfaction
- MeSH terms
- Adolescent, Adjuvants, Anesthesia, Anesthetics, Dissociative, Atropine, Child, Child, Preschool, Double-Blind Method, Drug Combinations, Female, Humans, Infant, Injections, Intramuscular, Ketamine, Male, Pain, Prospective Studies, Sialorrhea, Minor Surgical Procedures, Patient Satisfaction
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