Ketamine for Anesthetic Premedication in Children: Pearls, Pitfalls and Review of Clinical Utility

Ketamine, since its difficult introduction into clinical practice nearly half a millennium ago, has now become widely utilized as an anesthetic agent, especially in adults. Its efficacy in procedural anesthesia and pain management, along with its safety, has been proven in several clinical studies. This book chapter reviews the clinical utility of ketamine when used in young individuals. Premedication is an essential component of anesthetic protocol for parents and children to overcome emotional or psychological distress. Preoperative anxiety, being associated with greater pain during postoperative recovery in children, calls for the effective use of premedicants. This chapter describes how the cognizance of perioperative pain and the use of ketamine in children has become especially popular over the past few decades. It also discusses how intramuscular ketamine as a premedicant in subanaesthetic doses has a special role in the management of highly uncooperative children. As a potent analgesic, ketamine has a complex mechanism of action, producing a state of sedation, immobility, analgesia, amnesia, and dissociation from the environment. Some institutions are using ketamine in infants over 7 months and toddlers as part of premedication protocols for preoperative sedation, prevention of response to separation and intravenous access, and postoperative pain control in infants. This chapter also discusses the pearls and pitfalls in using ketamine in these challenging populations.