Ketamine

How it works

Acts principally as an NMDA-receptor antagonist, producing a dissociative state with analgesia and amnesia while largely preserving airway reflexes and respiratory drive.

Prescribing in practice

• Use only by clinicians trained in paediatric sedation/anaesthesia with full monitoring and resuscitation facilities, as laryngospasm, airway and respiratory complications can occur.
• It raises secretions, heart rate and blood pressure and may cause emergence phenomena; provide a calm recovery environment and manage accordingly.
• Confirm route and dosing against a children's formulary and local sedation protocols.

Monitoring

Monitor airway, oxygen saturation, respiration, heart rate and blood pressure throughout sedation and into recovery.

Counselling the patient

• Explain to parents the child may appear distant, have unusual eye movements or vivid dreams during recovery.
• Allow the child to recover quietly without unnecessary stimulation.
• Follow fasting and post-procedure observation instructions.

Evidence & guidelines

Ketamine is widely used and supported for paediatric procedural sedation and anaesthesia in monitored settings per the SPC and sedation guidance.