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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 com…