Guidance on the Safe Use of Ketamine Outside of Acute Pain Management and Procedural Sedation

Ketamine is an anesthetic medication that was developed and studied extensively for use in procedural sedation and anesthesia. Recently, researchers and clinicians have proposed additional uses, including the treatment of mental health disorders including PTSD and mood disorders. Some of these patients may benefit greatly from ketamine therapy.

Ketamine prescriptions are being written by health care professionals who are not themselves trained in the safe administration of anesthetic medications, like ketamine. Patients treated with ketamine at outpatient clinics, or in their home, may not have routine and immediate access to vital sign monitoring, rescue personnel, or emergency resuscitation equipment necessary when anesthetic agents are being used. Like other scheduled medications, including benzodiazepines and opioids, inappropriate administration of ketamine may lead to life-threatening consequences including respiratory failure, cardiac events, and seizures.

ASA strongly believes that the administration of ketamine should adhere to the same standards as other anesthetic medications.

1. The general principles of ketamine use for non-anesthesia indications should follow the same general prescribing principles as other sedating medications. See previous ASA communications regarding ketamine.
2. Ketamine should only be prescribed as part of a comprehensive treatment plan, for a medical indication, by an appropriately trained and licensed medical professional who is monitoring the plan with periodic face-to-face visits.
3. Ketamine treatment should have a therapeutic endpoint and a defined treatment course.
4. Medical professionals should take steps to ensure that the ketamine therapy is being used as prescribed.
5. Medical professionals should be vigilant for diversion to non-medical purposes.
6. Ketamine should be prescribed at the minimum dose necessary to achieve a desired clinical effect.
7. Patients should be educated about the possible adverse effects of ketamine use.
8. Ketamine should not be administered in doses that produce excessive sedation, unconsciousness or unresponsiveness, except when it is being used as a procedural anesthetic administered by a licensed health care professional in an appropriately equipped setting.
9. Intravenous and Intramuscular ketamine should only be administered in a monitored setting under the care of a licensed health care professional where appropriate rescue equipment is immediately available.