Ketamine is administered for procedural sedation in a 6-year-old child. Which premedication is routinely given to counteract one of the most consistent side effects of ketamine seen during the procedure?

• A Naloxone, to reverse respiratory depression
• B Ondansetron, to prevent gastric stasis
• C Neostigmine, to preserve airway reflexes
• D Glycopyrrolate, to reduce hypersalivation ✓

Explanation

Ketamine consistently stimulates salivary and tracheobronchial secretions, which can provoke laryngospasm, particularly in children undergoing airway procedures. An antisialagogue such as glycopyrrolate or atropine is therefore routinely co-administered. Ketamine does not cause clinically important gastric stasis, does not impair airway reflexes at sedative doses, and produces respiratory stimulation rather than depression, so options B, C and A address problems ketamine does not create.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.

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