The incidence of unpleasant dreams associated with emergence from ketamine anaesthesia can be reduced by administration of –
**Core Concept**
Ketamine, a non-competitive NMDA receptor antagonist, is associated with a range of psychopharmacological effects, including vivid dreams and hallucinations during emergence from anesthesia. This phenomenon is thought to be related to the drug's action on the limbic system, particularly the hippocampus and amygdala.
**Why the Correct Answer is Right**
Administration of benzodiazepines, such as midazolam, can reduce the incidence of unpleasant dreams associated with emergence from ketamine anesthesia by modulating the GABAergic system, which counteracts the excitatory effects of ketamine on the limbic system. Benzodiazepines enhance GABA receptor activity, leading to a decrease in the frequency and intensity of ketamine-induced dreams. This effect is thought to be mediated through the interaction of benzodiazepines with the GABA_A receptor complex, which is distinct from the NMDA receptor complex targeted by ketamine.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the management of ketamine-induced dreams.
**Option B:** Anticholinergics, such as atropine, do not have a direct effect on ketamine-induced dreams.
**Option C:** Opioid analgesics, such as fentanyl, may actually increase the incidence of dreams and hallucinations associated with ketamine anesthesia.
**Clinical Pearl / High-Yield Fact**
Benzodiazepines can be used to reduce the incidence of unpleasant dreams associated with emergence from ketamine anesthesia, but their use must be balanced against the potential for respiratory depression and other adverse effects.
**Correct Answer: D. Midazolam.**