Ketamine: Not Just for Pediatric Sedation?

Ketamine, an old drug with newly emerging clinical implications, offers an alternative agent for the management of acute pain in the pediatric emergency care setting. Subdissociative ketamine may be given by the intravenous route at doses of 0.3-0.8 mg/kg or by the intranasal route at a dose of 1 mg/kg. This review illustrates some of the gaps in our understanding between the mechanistic potential of ketamine and the actual evidence of clinical effects. The analgesic effects of ketamine result from a complex array of receptor interactions that modulate pain. The complex actions of ketamine make it a potentially superior agent to opioid medications, although data to support this are lacking. This article focuses on ketamine for acute pain and reviews the mechanism of action, dosing, routes of administration, adverse effects, and gaps in our current understanding of how the drug modulates pain.