First synthesized in 1962 as an offshoot of phencyclidine, ketamine quickly became a staple in both veterinary and human medicine due to its unique properties as a dissociative anesthetic. It is particularly valuable in the pediatric setting because it provides effective anesthesia while maintaining protective airway reflexes, spontaneous breathing, and cardiovascular stability (1). Unlike typical anesthetics that act on gamma-aminobutyric acid (GABA) receptors, ketamine acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. This mechanism of action is beneficial for pain management and provides sedation without the significant respiratory or cardiovascular depression associated with many other anesthetics. In addition, ketamine’s ability to stimulate the sympathetic nervous system may be beneficial in maintaining hemodynamic stability by increasing cardiac output and blood pressure, which is particularly important in the management of critically ill or unstable pediatric patients (2).
The utility of ketamine in pediatric anesthesia is underscored by its safety profile, particularly in settings with limited access to comprehensive anesthesia equipment and expertise. Its preservation of upper airway muscle tone and reduced risk of respiratory depression make it ideal for emergency procedures. However, its side effects should be noted, and anesthesia protocols may benefit from using ketamine alongside other medications. For example, research by Wang et al. (2023) suggested that a combination of ketamine and propofol enhanced anesthetic efficacy and reduced side effects such as postoperative nausea and respiratory complications compared to ketamine alone (1). This combination, which favors the complementary effects of both drugs, offers a smoother recovery and better overall outcomes for pediatric patients.
Beyond its primary use in surgical anesthesia, ketamine’s applications extend to other areas of pediatric care. It is increasingly used for procedural sedation in non-surgical contexts such as diagnostic imaging and minor procedures, where its rapid onset and short duration minimize the time children spend under sedation, thereby reducing the overall stress for both patients and their families. In addition, ketamine’s role in pediatric emergency medicine is growing. It is particularly effective in treating pediatric patients with acute severe asthma attacks, providing rapid bronchodilation without the cardiovascular suppression often seen with other sedatives (3). This unique property makes ketamine a critical resource in emergency settings where rapid stabilization of respiratory function is paramount.
Despite its benefits, the use of ketamine in pediatric patients is not without challenges. Emergence reactions, such as hallucinations and delirium, can be particularly distressing for young patients and their caretakers. Effective management strategies, including the co-administration of midazolam, have been shown to reduce these adverse effects and provide a more comfortable recovery period for children (1).
Current research continues to expand the therapeutic applications of ketamine beyond its fundamental role in pediatric anesthesia. Studies have suggested potential anti-inflammatory and neuroprotective effects, particularly in the treatment of acute conditions such as severe asthma and in modulating neuroplasticity in neurodevelopmental disorders. Its rapid bronchodilatory action without significant cardiovascular suppression makes it particularly valuable in emergency settings, providing rapid stabilization of respiratory function (3). These applications highlight ketamine’s versatility, emphasizing its vital role in pediatric care through providing customized, effective treatments that improve results for some of the most at-risk patients.
References
- Wang W, Cai W, Shao H, Ni H. Assessing pediatric anesthesia outcomes and prognostic factors: a comparative study of ketamine vs. ketamine + propofol. Am J Transl Res. 2023;15(10):6095-6105. Published 2023 Oct 15.
- Hayes JA, Aljuhani T, De Oliveira K, Johnston BC. Safety and Efficacy of the Combination of Propofol and Ketamine for Procedural Sedation/Anesthesia in the Pediatric Population: A Systematic Review and Meta-analysis. Anesth Analg. 2021;132(4):979-992. doi:10.1213/ANE.0000000000004967
- Dwivedi P, Patel TK, Bajpai V, Singh Y, Tripathi A, Kishore S. Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2022;69(11):1405-1418. doi:10.1007/s12630-022-02305-1