Question: Can you think of some disadvantages of using ketamine in children?

Answer: Disadvantages include:

• Patients can have lots of secretions; atropine may be used to reduce these
• Laryngospasm may occur. Avoid using airway adjuncts such as an oral airway
• Ketamine does not relax the muscles. It may cause increased muscle tone which may make surgery more difficult
• Tachyphylaxis may occur if the operation takes longer than 45 minutes (patients need more drug to get the same effect).
• Recovery may be slow. The child should be monitored until they are fully recovered.
• Ketamine produces 'dissociative anaesthesia' - children may not seem to go to sleep compared with a standard general anaesthetic. They may keep their eyes open and make reflex movements during surgery
• Ketamine may cause hallucinations or bad dreams in older children when the child wakes up. Benzodiazepines or opioids may be used to reduce the chance of this occurring (not required in young children). Recover the child in a quiet environment, taking care to monitor them at all times