Effectiveness of Atropine and Glycopyrrolate to Reduce Hyper Salivation With Ketamine Sedation

Ketamine is a common sedation agent used in the pediatric emergency department for a variety
of procedures, used in clinical practice since 1970. One potential side effect of Ketamine
is hypersalivation, potentially leading to laryngospasms. To prevent hypersalivation (and
reduce the potential for laryngospasms), an anti-salivary agent, such as Atropine, is
commonly given in combination with Ketamine. Recently, however, the necessity of this
practice has been brought into question. The consideration of using a different drug,
glycopyrrolate, has been debated. The purpose of this study is to compare the effectiveness
of each medication in addition to the placebo control.

Patients enrolled into this study must present to the emergency department or abscess clinic
with the need to receive Ketamine as part of a sedation procedure (as determined by the
treating physician). This study will randomize enrolled patients to receive double-blinded
Atropine, Glycopyrrolate or placebo given 30 minutes prior to Ketamine. After Ketamine is
administered, a trained medical person will suction the patient's mouth every 5 minutes for
a total of 30 minutes, collecting all oral secretions. Total saliva production will be
measured and salivary flow rates will be calculated and compared between each assigned
group. Adverse events and complications will be monitored throughout the patient's stay in
the emergency department or abscess clinic.