Coadministered Anticholinergics

Ketamine Administration: IM Route
The minimum IM dose in children at which the dissociative
state can be reliably achieved is 4 to 5 mg/kg.4,18,19,23 Should
this initial dose result in insufficient procedural conditions, a
repeated half dose or full dose is essentially always effective.19,23
The IM route is extremely uncommon and not preferred in
adults, but similar 4 to 5 mg/kg dosing is effective.4
Coadministered Anticholinergics
Traditionally the prophylactic coadministration of an
anticholinergic (ie, atropine or glycopyrrolate) has been routinely
recommended, with the intent of mitigating oral secretions and
thus presumably airway adverse events.1,12,15,16 However, large
case series of patients have been safely treated without this
adjunct.35,80 The large meta-analysis found anticholinergics to
be associated with significantly more airway and respiratory
adverse events and significantly less vomiting; however, both
were at magnitudes of doubtful clinical importance.2,3,81 Given
this lack of tangible benefit or harm, the literature is not
supportive of anticholinergic prophylaxis. Instead, these drugs
could be reserved for the treatment of unusual occurrences of
clinically important hypersalivation or for patients with an
impaired ability to mobilize secretions.