What is a key consideration when using dissociative agents?

• A. Combine with muscle relaxants, increase sympathetic tone, and no reversal
• B. Use as a sole agent with a quick reversal
• C. Always provide analgesia with reversal
• D. Avoid any muscle relaxation

Answer: (A)

Dissociative agents like ketamine provide analgesia and a dissociated state while often increasing sympathetic activity and muscle tone. A key point when using them is that there isn't a specific antidote or reversal agent available, so management relies on supportive care and using adjuncts to smooth the course and control effects. To counteract potential muscle rigidity and hemodynamic stimulation, clinicians commonly combine the dissociative with a muscle relaxant (and often with a sedative such as a benzodiazepine) rather than waiting for a reversal. This approach reflects the practical reality that recovery can be managed with careful dosing and adjuncts, not with a reversal drug.