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My experience with ketamine has all been good.
we premedicate with an amnestic agent so patients don't recall if they have "nightmares" which are reportedly pretty common.
We tend not to use it in patients with traumatic brain injuries because of experimental rises in ICPs in some animals (I believe they were all obstructed but I cannot remember offhand)...it is controversial but many do still use it with TBI patients.
The risk of severe laryngospasm is a bigger concern. It occurs rarely but when it does can be devastating as the patients typically do not have an airway. I have not seen it...alot of the patients tend to snore loudly but that is neither here nor there. One of my partners had to cric someone as they were unable to intubate when it occurred... so its real and you need to be prepared for it.
Overall, patients tolerate it well...
doc t.
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