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, combative and violent behavior may pose a physical danger to the patient, caretakers, and the anesthesia care team. The use of intramuscular (IM) sedative agents, which does not require patient cooperation, can facilitate an efficient transfer to the OR and induction of GA. Although IM ketamine is effective and commonly used for the management of special need patients, it has numerous undesirable side effects including dysphoria, hypersalivation, hyperreactive airway reflexes, hypertension, tachycardia, muscle hypertonia, hallucinations, increased incidence of

use of intravenous dexmedetomidine and ketamine for dental extraction in children with cyanotic heart disease with positive results. 17 Both midazolam and ketamine are intravenous sedative agents used most commonly in combination with other drugs for dental procedures. Midazolam is a good anxiolytic, amnestic agent but is known to pose difficulties to the operator for longer and more complex dental procedures when used alone. 18 It also poses the risk of respiratory depression at high doses and has minimal analgesic effects, 19 , 20 limiting its utility as

from the dental office. These adverse effects may be mitigated by avoiding or minimizing opioid dosages or by utilizing a rapidly metabolized opioid such as remifentanil. 6 Continuous infusion of subhypnotic doses of propofol has been used successfully to prevent and treat PONV. 7 , 8 Infusion of propofol in combination with remifentanil has been demonstrated to decrease the incidence of PONV in comparison to an infusion of remifentanil alone. 9 Ketamine, a phencyclidine derivative, is an N-methyl-D-aspartate (NMDA) receptor antagonist that produces a state

, and patients may experience signs and symptoms in other parts of the body. Although the pattern of spread is not well understood, involvement spreading to the contralateral limb is usually 2.3 times higher than the ipsilateral and diagonal area. Diagonal spread is usually triggered by new trauma, unlike ipsilateral and contralateral spread. 18 CRPS Management and Ketamine Specific treatment protocols for CRPS types I and II are not yet well-defined. Treatment modalities have included bisphosphonates, botulinum toxin A, calcitonin

of which is ketamine. Ketamine is an N -methyl- d -aspartate receptor antagonist often used to provide sedation and/or augment analgesia in painful surgical procedures. 10 Ketamine causes an increase in sympathetic tone, leading to an increased heart rate (HR), cardiac output, and blood pressure (BP). In addition, ketamine preserves the airway reflexes and produces minimal respiratory depression. 11 , 12 However, its cardiostimulatory effects and unwanted side effects, which include hypersalivation, 13 limit its use as a single intravenous agent for

, 2020. Participation was voluntary with no offered incentive for completion. The survey included 13 items assessing respondent and patient demographics, frequency of preoperative IM sedation use, practice location, drugs and dosages used, the intended level of sedation using the Richmond Agitation and Sedation Scale (RASS), success at achieving the intended level of sedation, use of anticholinergics, factors influencing ketamine dosing, and occurrence of select adverse events (Appendix 1). Statistical Analysis All surveys were evaluated for

-gauge peripheral IV was secured on the dorsum of the right hand and administration of a Lactated Ringers solution was initiated. The patient was slowly induced with IV boluses of diphenhydramine 50 mg and ketamine 50 mg, plus a dexmedetomidine 70 mcg bolus given over 10 minutes that was converted to a continuous infusion of 0.7 mcg/kg/h with an infusion pump and titrated to achieve deep sedation. She maintained a patent unobstructed airway and spontaneous ventilations, achieving an SpO 2 of 98 to 100% with supportive neck and shoulder rolls to facilitate head