Ketamine's psychological effects do not contraindicate its use based on a patient's occupation.

Since ketamine was approved for clinical use, there has been debate over whether the psychological effects of ketamine warrant avoiding use of the drug in patients based on their occupation. This article reviews the literature to determine if such concerns are valid. After 25 years of clinical experience with ketamine, fewer than 10 cases document the occurrence of delayed psychological effects potentially attributable to that drug. In most cases, the delayed effects were temporary, resolving within 3 weeks. Further, there were no long-term psychological effects clearly attributable to ketamine. Children who manifested delayed effects had several other factors present placing them at risk for long-term psychological changes independent of their receiving ketamine. Several controlled studies investigating the risk of long-term psychological effects due to ketamine fail to document that the risk of permanent psychological changes from ketamine is any greater than that from any other anesthetic. In conclusion, there is no evidence in the literature that ketamine presents a higher risk compared to other anesthetics for causing long-term psychological effects that result in a patient not being able to return to his or her occupation. The decision of whether to use ketamine should be a clinical decision weighing relative risks versus benefits, and not a decision based on the patient's career.