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Chapter 35. Airway Management of an Uncooperative Down Syndrome Patient with an Upper GI Bleed

Down syndrome patients are known to have the following attributes that may lead to failed intubation:

A. obstructive sleep apnea

B. large tongue

C. tendency to have subglottic stenosis

D. C-spine subluxation

E. all of the above

(E) Down syndrome patients are known to have all these attributes that may lead to failed intubation.

Ketamine used in the uncooperative patient

A. aggravates the degree of cooperation because it is a dissociative agent

B. produces such salivation that laryngospasm is a common problem

C. is contraindicated because of the high incidence of emergency delirium

D. can be administered PO or IM

E. midazolam has been proven to reduce the incidence of ketamine-induced emergency delirium in adults and children

(D) Even though emergence delirium can occur (incidence varies but may be as high as 10%–30% in adults with a much lower occurrence in children), oral and IM ketamine remains a useful drug in the management of uncooperative patient. Unfortunately, midazolam has not been shown to reduce the incidence of ketamine-induced emergency delirium.

Oral or IM ketamine is useful in the management of the uncooperative patient. Which of the following is TRUE?

A. The dose of oral ketamine is 7.0 mg·kg−1.

B. Midazolam prevents emergence reactions.

C. Glycopyrrolate should be coadministered with ketamine to prevent laryngospasm.

D. Ketamine is contraindicated in developmentally delayed individuals.

E. All of the above.

(A) Ketamine is useful in the management of uncooperative patients, including mentally challenged individuals and the dose of oral dose is 7.0 mg·kg−1.

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