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.