Ketamine Without Atropine

Is Ketamine Sedation Without Atropine Prophylaxis Safe in Children?
Findings of an observational study suggest that it is.

Because ketamine can cause hypersalivation, adjunctive atropine prophylaxis traditionally has been recommended for sedation in children. However, many emergency physicians no longer administer atropine prophylaxis. In a prospective observational study, researchers evaluated the incidence of hypersalivation and associated airway compromise in children who were undergoing ketamine sedation in an emergency department where atropine was administered at the treating physician's discretion.

Of 1090 children who received ketamine for sedation during a 3-year period, 87% did not receive atropine. Among patients who did not receive atropine, 4% developed excessive salivation that required intervention (mostly suctioning) and 3% experienced airway compromise. Only one case of airway compromise was thought to be related to hypersalivation. No child required intubation. The authors conclude that routine atropine prophylaxis is not necessary when ketamine is used for sedation in children.

Comment: Of the nearly 1000 children who were sedated with ketamine without atropine in this observational study, none required assisted ventilation or intubation, even though 4% developed hypersalivation. Many practitioners have stopped using adjunctive atropine, and the practice seems to be safe.

— Diane M. Birnbaumer, MD, FACEP
Published in Journal Watch Emergency Medicine May 2, 2008
Citation(s): Brown L et al. Adjunctive atropine is unnecessary during ketamine sedation in children. Acad Emerg Med 2008 Apr; 15:314.