If ketamine or tiletamine-zolazepam is added to a Fear Free protocol, which statement is correct?

• A. Consider this to be general anesthesia and monitor/support the patient appropriately
• B. Don't worry about the patient because these drugs don't cause adverse effects
• C. The patient is probably ASA V
• D. The patient is easy to handle since these are weak drugs

Answer: (A)

The key idea is that adding ketamine or tiletamine-zolazepam moves the patient toward general anesthesia rather than light sedation, so you must manage and monitor them with anesthetic-level care. These drugs are potent and carry meaningful risks that can affect breathing, circulation, and recovery. Ketamine can stimulate the heart and increase blood pressure, while tiletamine-zolazepam (Telazol) can cause respiratory depression, airway difficulty, or prolonged sedation. Because of these potential adverse effects, treat the situation as general anesthesia and prepare accordingly.

This means thorough preparation: pre-anesthetic assessment, ensuring IV access and appropriate fluids, having oxygen and airway equipment ready, and continuous monitoring of heart rate and rhythm, blood pressure, respiratory rate and pattern, pulse oximetry, and ideally capnography. Be ready to support ventilation if needed and manage emergence carefully during recovery. The answer isn’t about “weak drugs” or ignoring risks; it reflects the reality that these agents require anesthesia-style monitoring and support.

Other options mischaracterize the scenario: these agents are not just mild sedatives to be ignored for adverse effects, they do carry significant anesthesia-related risks; and assuming the patient is an easy case or automatically ASA V misunderstands the intended level of care and possible pre-existing conditions.