Unique clinical situations in pediatric patients where ketamine may be the anesthetic agent of choice.

Ketamine has been recognized as an anesthetic agent of choice in areas with limited resources, particularly in emergency situations. Unlike other commonly used induction agents, it preserves respiratory drive and maintains predominant sympathetic tone. However, ketamine's application in other clinical settings has been limited by its psychomimmetic properties, which other anesthetics do not posses. Despite these drawbacks, ketamine has become a favorable drug for the sedation of children undergoing various procedures. Here we propose 3 clinical paradigms where ketamine may be the agent of choice for the pediatric patient requiring sedation or anesthesia, including (1) the child with a difficult airway, (2) the child with a reactive airway disease, and (3) the uncooperative child requiring intravenous access.