Pediatric Pearls - Tachycardia Out of Proportion


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Ian L. -

There is a concern with the use of ketamine in infants with small airways because ketamine produces hypersalivation.
Noted in several trials .
Heinz P et al Emergency MED 2006 March 23. (3) 206-209 .
The question is whether it is of clinical significance .
Brown L et Acad Emerg MED 2008 .
The authors noted hypersalivation greater without atropine but not "excessive "
The concern is ketamine without atropine anaesthesia in croup where hypersalivation ought matter .
In this case immediate Echo before EKG is a consideration .

Tracy G. -

From Ilene Claudius: Absolutely a concern! I'm sure we all remember when ketamine was contraindicated below a year and for any oropharyngeal procedures. The latest 2011 ACEP guidelines, of course, have decreased the lower age limit to 3 months and procedures which may stimulate the larynx were downgraded to a relative contra-indication after a large study showed no increase in laryngospasm. Of course, this is all for procedural sedation which is typically, to some degree, elective. In this kid, there were few alternatives and I think the possibility of benefit outweighed the risk. Atropine, or may glycopyrrolate (since tachycardic) would have been reasonable if salivation became an issue.

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