Clinical practice guideline for emergency department ketamine dissociative sedation in children

Changing Trends in Dental Procedural Sedation

“…It has strong analgesic action even at sub-anesthetic dose and with this dose it does not impair upper airway reflexes and thus allowing patient to breathe spontaneously and maintain the protective reflexes. However, though the reflexes may remain intact, but cannot be assumed to be protective [31] . Ketamine has dosed related side-effects notably increased muscle tone, may cause rigidity, increase in blood pressure and may results in a dissociative state and patient may not be able to speak or respond purposefully to verbal commands.…”

“…The risk of laryngospasm may be greater in dental patients as the procedure itself can stimulate the oropharynx, presence of secretion and blood in orophrynx can stimulate laryngeal reflexes. Prevention of secretions by using antisialogogue and preventing blood from accumulating in the posterior pharynx and avoiding excessive stimulation of this region with suction device or other instruments in patients receiving ketamine for dental sedation [31] . Incidences of delirium and other side-effects can be minimized by limiting the dose of ketamine or using it in conjunctions with other sedative hypnotic.…”

Induction Agents for Endotracheal Intubation in Severe Sepsis and Septic Shock

“…The mechanism seems to be linked to airway sensitivity. Ketamine preserves airway reflexes and may cause increase airway responsiveness to secretions (56). Ketamine is connected to a phenomenon known as reemergence.…”

Management of Pain in the Emergency Department

“…Hypersalivation, vomiting, laryngospasm, and unpleasant emergence reactions are among the major nonhemodynamic issues that should be considered when ketamine is used in any dose (risk of side effects does not appear to be dose dependent) [120,[124][125][126][127][128][129][130][131]. Hemodynamically, ketamine's sympathomimetic effects are well known to be associated with increases in heart rate and blood pressure, but the latest data indicate that there is little reason for concern about the more important issue of hemodynamic stimulation's adverse impact on intracranial pressure [132,133].…”