Introduction

Here is the complete list of contra-indications from the College guideline:

• Age less than 12 months
• Active respiratory infection, active asthma
• Unstable or abnormal airway. Tracheal surgery or stenosis
• Active upper or lower respiratory tract infection
• Proposed procedure within the mouth or pharynx
• Patients with severe psychological problems such as cognitive or motor delay or severe behavioural problems
• Significant cardiac disease
• Recent significant head injury or reduced level of consciousness
• Intracranial hypertension with CSF obstruction
• Intra-ocular pathology
• Previous psychotic illness
• Uncontrolled epilepsy
• Hyperthyroidism or thyroid medication
• Porphyria
• Prior adverse reaction to ketamine

A relative contra-indication that might result in a child receiving in-patient general anaesthesia (GA), is commonly a lack of adequate ED resources – typically because of excess departmental workload.

Learning bite

• The College guideline allows you to proceed with ketamine sedation for non-fasted children, if the clinical need dictates urgent action.
• Specific contraindications to ketamine sedation include infants and children with URTIs or significant learning difficulties.