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All over the world, ketamine has been and is used in pediatric analgesia and anesthesia for the benefit of our little patients thanks to its typical pharmacological profile. Ketamine may be administered in the continuum of care from pre-hospital settings to in-hospital management up to pediatric intensive care. Even in countries with limited resources, under disaster conditions, and in hostile environments, ketamine is mostly accessible. However, a very important concern with the use of ketamine is the risk of dose-dependent neurodegenerative effects in infants and especially seriously sick, young children. In view of increased knowledge and recent advancements in perioperative and intensive care management of pediatric patients, we will share our expertise and discuss ketamine’s potential in three challenging scenarios: (1) Caudal regional anesthesia in a preterm born, 6-month-old baby, (2) general anesthesia with adjunctive perioperative ketamine to improve postoperative recovery and pain relief in a 3-year-old toddler, and (3) sedation and analgesia with adjuvant ketamine in mechanical ventilation of a (difficult-to-sedate) 8-year-old schoolchild without or with intracranial hypertension in the pediatric intensive care unit.

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Achieving Pediatric Anesthesia and Analgesia Goals with Minimum Unwanted Impact Is Not Just Drug Dose-Titration in Little Adults: Key Aspects with Ketamine in Three Challenging Situations

  • 实验方案

  • 发表日期：

    2025年

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  • Alessandro Simonini,
  • Etrusca Brogi

摘要

All over the world, ketamine has been and is used in pediatric analgesia and anesthesia for the benefit of our little patients thanks to its typical pharmacological profile. Ketamine may be administered in the continuum of care from pre-hospital settings to in-hospital management up to pediatric intensive care. Even in countries with limited resources, under disaster conditions, and in hostile environments, ketamine is mostly accessible. However, a very important concern with the use of ketamine is the risk of dose-dependent neurodegenerative effects in infants and especially seriously sick, young children. In view of increased knowledge and recent advancements in perioperative and intensive care management of pediatric patients, we will share our expertise and discuss ketamine’s potential in three challenging scenarios: (1) Caudal regional anesthesia in a preterm born, 6-month-old baby, (2) general anesthesia with adjunctive perioperative ketamine to improve postoperative recovery and pain relief in a 3-year-old toddler, and (3) sedation and analgesia with adjuvant ketamine in mechanical ventilation of a (difficult-to-sedate) 8-year-old schoolchild without or with intracranial hypertension in the pediatric intensive care unit.