Adjunctive Atropine Is Unnecessary during Ketamine Sedation in Children

Brown, Lance; Christian‐Kopp, Sarah; Sherwin, Thomas; Khan, A. H.; Barcega, Besh; Denmark, T. Kent; Moynihan, James A.; Kim, Grace J.; Stewart, Gail; Green, Steven M.

doi:10.1111/j.1553-2712.2008.00074.x

Cited by 57 publications

(20 citation statements)

References 17 publications

(35 reference statements)

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“…1,2 Our study showed no efficacy for either anticholinergic in reducing airway complications and support the conclusion of Brown et al 2 that coadministered anticholinergics are not routinely necessary during ketamine sedation.…”

Section: Discussionsupporting

confidence: 83%

“…1,2 Their efficacy in this role is controversial, with study results both pro 3 and con. 2,4,5 It is possible that the conflicting evidence on this issue results from differences between the two anticholinergics typically used-atropine and glycopyrrolate. Unlike atropine, the synthetic glycopyrrolate does not cross the blood-brain barrier and thus exhibits less influence on the central nervous system.…”

mentioning

confidence: 99%

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Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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Objectives: Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. The authors contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations.Methods: This was a secondary analysis of an observational database of 8,282 ED ketamine sedations assembled from 32 prior series. The authors compared the relative incidence of six adverse events (airway and respiratory adverse events, laryngospasm, apnea, emesis, recovery agitation, and clinically important recovery agitation) between children who received coadministered atropine, glycopyrrolate, or no anticholinergic. Multivariable analysis using the specific anticholinergic as a covariate was performed, while controlling for other known predictors.Results: Atropine was associated with less vomiting (5.3%) than either glycopyrrolate (10.7%) or no anticholinergic (11.4%) in both unadjusted and multivariable analyses. Glycopyrrolate was associated with significantly more airway and respiratory adverse events (6.4%) than either atropine (3.3%) or no anticholinergic (3.0%) and similarly more clinically important recovery agitation (2.1% vs. 1.2 and 1.3%). There were, however, no differences noted in odds of laryngospasm and apnea.Conclusions: This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation. Any such advantage requires confirmation in a separate trial; however, our data cast doubt on the traditional premise that glycopyrrolate might be superior. Further, neither anticholinergic showed efficacy in decreasing airway and respiratory adverse events.ACADEMIC EMERGENCY MEDICINE 2010; 17:157-162 ª

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Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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“…32 A large case series of patients showed the safety profile of ketamine when coadministered anticholinergics were omitted and excessive salivation was uncommon. 33 With ketamine use there has been concern for laryngospasm, which is uncommon. Laryngospasm is typically easily corrected with bag-valve mask ventilation.…”

Section: Dissociative Agents Ketaminementioning

confidence: 99%

Pediatric Procedural Sedation and Analgesia

Pacheco¹,

Ferayorni²

2013

Emergency Medicine Clinics of North America

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“…Il n'y a pas de bénéfice à associer à la kétamine ni l'atropine [2] ni une benzodiazépine. Une étude pharmacodynamique a précisé le profil de la kétamine chez 43 enfants [14] : la concentration plasmatique de 1,5 mg/l est atteinte, en trois à quatre minutes, chez 95 % des enfants ayant reçu par voie i.v.…”

Section: Autres éTudes Cliniquesunclassified

Ketamine for paediatric procedure-related pain

Annequin

2010

Douleur analg

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Les premières recommandations françaises de l'Agence française de sécurité sanitaire des produits de santé (Afssaps) de bonne pratique pour la réalisation de soins et d'actes douloureux chez l'enfant ont été finalisées en 2009 ; il n'existait pas jusqu'alors en France, de recommandations permettant de faire bénéficier les enfants d'une sédation-analgésie plus puissante que le mélange équimoléculaire oxygène-protoxyde d'azote (MEOPA), dont l'efficacité est inconstante. Pour effectuer dans de bonnes conditions un geste douloureux, la kétamine à faible dose (titration de bolus intraveineux [i.v.] de 0,5 mg/kg sans dépasser 2 mg/kg) apparaît comme étant le seul médicament potentiellement utilisable par un médecin formé, sans la présence d'un médecin anesthésiste. Avec ces posologies, sans association médica-menteuse, le niveau de sécurité optimal dépend largement de la qualité de l'environnement hospitalier. La voie intramusculaire (i.m.) (< 4 mg/kg) est une alternative (si la voie intraveineuse n'est pas facilement disponible), mais le délai de récupération est retardé. Mots clés Kétamine · Douleur provoquée par les soins · Enfant · Sécurité · RecommandationAbstract For painful procedures, there was not any recommendations in France to date allowing children to benefit from more powerful sedation-analgesia than nitrous oxideoxygen mixture, whose efficacy is inconsistent. In order to perform a painful procedure under good conditions, lowdose ketamine (0.5 mg/kg IV. bolus titration, not exceeding 2 mg/kg) appears to be the only medication that can be used by a trained physician, without requiring the presence of an anesthesiologist). With these posologies, with no drug combinations, the optimum safety level is largely governed by the quality of the hospital environment. The intramuscular route (< 4 mg/kg) is an alternative (if the IV route is not readily available), but the recovery time is delayed.

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Adjunctive Atropine Is Unnecessary during Ketamine Sedation in Children

Cited by 57 publications

References 17 publications

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Pediatric Procedural Sedation and Analgesia

Ketamine for paediatric procedure-related pain

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