Ketamine is best for all but: which scenario is not ideal?

• A. Patients that need extra chemical control but not necessarily general anesthesia
• B. Patients who weigh <7 kg
• C. Patients who no longer need sedation
• D. Hospitals that do not want to carry tiletamine-zolazepam

Answer: (C)

Ketamine shines when there is a need for sedation or anesthesia with analgesia, without committing to a full general anesthetic. It provides dissociative anesthesia and analgesia while often preserving airway reflexes, which makes it useful for short procedures, for extra chemical control when you don’t want a full GA, for very small patients where careful dosing is important, and as an alternative in settings where tiletamine-zolazepam isn’t available or desired.

The scenario that isn’t ideal for ketamine is when the patient no longer needs sedation. If there’s no need for sedative or analgesic effects, administering ketamine adds unnecessary exposure to anesthetic drugs and potential side effects without any benefit, whereas the other situations involve situations where sedation or analgesia is actually indicated.