Ketamine Emergence — FRCA Primary MCQ
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Correct answer: E — Ketamine
Ketamine is the correct answer. During recovery from ketamine anaesthesia, emergence reactions may include vivid imagery or dreams, hallucinations, nightmares, confusion, excitement and emergence delirium. Ketamine produces dissociative anaesthesia, principally through non-competitive antagonism of central NMDA receptors; disruption of thalamocortical and limbic processing contributes to its characteristic perceptual effects. A quiet, minimally stimulating recovery environment may reduce these reactions, and benzodiazepines can reduce their incidence. Propofol and thiopentone more typically produce smooth hypnosis, although non-specific dreaming may occur. Etomidate is particularly associated with myoclonus, pain on injection, postoperative nausea and vomiting, and adrenocortical suppression. Midazolam usually produces anxiolysis and anterograde amnesia and may be used to reduce ketamine-associated emergence reactions.
Reference: hameln pharma ltd. Ketamine 50 mg/ml Injection, Summary of Product Characteristics, sections 4.2, 4.4, 4.8 and 5.1; revised 2025. https://www.medicines.org.uk/emc/product/6935/smpc