Ketamine side-effects

Q: Ketamine may cause? (select one)

A) dry-mouth

B) salivation 

Answer: B

Ketamine has become popular in ICUs for sedation and pain management. It is imperative to know its common side effects, one of which is extreme sialorrhea. Non-pharmacologic interventions such as suctioning and proper positioning.

The drug of choice is glycopyrrolate with a single IV dose of 5 mcg/kg IV which can be repeated every two to three minutes with a maximum total dose of 0.8 mg. 

Atropine can also be utilized with a single IV  dose of 0.01 to 0.02 mg/kg IV, with a maximum dose of 1.2 mg. While using Atropine, cardiac effects should be kept in mind.

Ideally, glycopyrrolate or atropine should be kept at the bedside while ketamine is infusing.

#pharmacology

References:

1. Toft P, Rømer UD. Glycopyrrolate compared with atropine in association with ketamine anaesthesia. Acta Anaesthesiol Scand 1987; 31:438.

2. Orhurhu VJ, Vashisht R, Claus LE, Cohen SP. Ketamine Toxicity. 2023 Jan 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31082131.

3. Schep LJ, Slaughter RJ, Watts M, Mackenzie E, Gee P. The clinical toxicology of ketamine. Clin Toxicol (Phila). 2023 Jun;61(6):415-428. doi: 10.1080/15563650.2023.2212125. Epub 2023 Jun 2. PMID: 37267048.