Ketamine Emergence Phenomena — FRCA Final MCQ
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Correct answer: D — Diazepam 5–10 mg IV
The correct answer is D. Vivid hallucinations, agitation and irrational behaviour during recovery are characteristic ketamine emergence phenomena. Initial management is observation in a quiet environment with minimal verbal and tactile stimulation. When severe symptoms persist, the UK ketamine SmPC recommends considering diazepam 5–10 mg IV in an adult. Benzodiazepines enhance GABA-A receptor-mediated inhibition and attenuate ketamine-related perceptual and behavioural disturbance; respiratory function must be monitored because sedation may prolong recovery and impair ventilation. Naloxone reverses opioid toxicity, which is not present. Ondansetron treats nausea and vomiting. Haloperidol is used for some causes of severe delirium but is not the specifically recommended treatment for ketamine emergence delirium. An unplanned propofol bolus may cause hypotension, apnoea and loss of airway reflexes and is not the appropriate first-line treatment in this spontaneously breathing trauma patient.
Reference: Panpharma, Ketamine 50 mg/ml Solution for Injection, Summary of Product Characteristics, section 4.2: Management of patients in recovery, revised 24 January 2025. https://www.medicines.org.uk/emc/product/2420/smpc