Editing Ketamine (section)

== Medical uses ==
[[File:Two doses of iv ketamine.jpg|thumb|Two doses of injectable ketamine, 50mg/ml and 10mg/ml]]

=== Anesthesia ===
The use of ketamine in anesthesia reflects its characteristics. It is a drug of choice for short-term procedures when [[Muscle contraction|muscle relaxation]] is not required.<ref name="Ketamine">{{cite book|vauthors=Rosenbaum SB, Gupta V, Palacios JL|chapter=Ketamine|date=2020|url=http://www.ncbi.nlm.nih.gov/books/NBK470357/|title=StatPearls|publisher=StatPearls Publishing|pmid=29262083|access-date=5 March 2020|archive-date=12 November 2020|archive-url=https://web.archive.org/web/20201112215028/https://www.ncbi.nlm.nih.gov/books/NBK470357/|url-status=live}}</ref> The effect of ketamine on the [[respiratory system|respiratory]] and [[circulatory system]]s is different from that of other anesthetics. It suppresses breathing much less than most other available anesthetics.<ref name="heshmati">{{cite journal | vauthors = Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A | title = Use of ketamine in severe status asthmaticus in intensive care unit | journal = Iranian Journal of Allergy, Asthma, and Immunology | volume = 2 | issue = 4 | pages = 175–80 | date = December 2003 | pmid = 17301376 | url = http://ijaai.tums.ac.ir/index.php/ijaai/article/view/52/52 | url-status = live | archive-url = https://web.archive.org/web/20141006100116/http://ijaai.tums.ac.ir/index.php/ijaai/article/view/52/52 | archive-date = 6 October 2014 }}</ref> When used at anesthetic doses, ketamine usually stimulates rather than depresses the circulatory system.<ref>{{cite journal | vauthors = Adams HA | title = [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation] | language = DE | journal = Der Anaesthesist | volume = 46 | issue = 12 | pages = 1081–7 | date = December 1997 | pmid = 9451493 | doi = 10.1007/s001010050510 | s2cid = 36323023 | trans-title = S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation }}</ref> Protective airway reflexes are preserved,<ref name="WongLee2014">{{cite journal | vauthors = Wong JJ, Lee JH, Turner DA, Rehder KJ | title = A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children | journal = Expert Review of Respiratory Medicine | volume = 8 | issue = 4 | pages = 423–41 | date = August 2014 | pmid = 24993063 | doi = 10.1586/17476348.2014.915752 | s2cid = 31435021 }}</ref> and it is sometimes possible to administer ketamine anesthesia without protective measures to the airways.<ref name="Ketamine"/> [[Psychotomimetic]] effects limit the acceptance of ketamine; however, [[lamotrigine]]<ref name="pmid10711913" /> and [[nimodipine]]<ref name="pmid11750186" /> decrease psychotomimetic effects and can also be counteracted by [[benzodiazepine]]s or [[propofol]] administration.<ref name="pmid32826629" /> [[Ketofol]] is a combination of ketamine and [[propofol]].

Ketamine is frequently used in severely injured people and appears to be safe in this group.<ref name="The effect of ketamine on intracran">{{cite journal | vauthors = Cohen L, Athaide V, Wickham ME, Doyle-Waters MM, Rose NG, Hohl CM | title = The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review | journal = Annals of Emergency Medicine | volume = 65 | issue = 1 | pages = 43–51.e2 | date = January 2015 | pmid = 25064742 | doi = 10.1016/j.annemergmed.2014.06.018 }}</ref> It has been widely used for emergency surgery in field conditions in war zones,<ref name="pmid25886322"/> for example, during the [[Vietnam War]].<ref name="pmid28731926">{{cite journal |vauthors=Mion G |title=History of anaesthesia: The ketamine story – past, present and future |journal=Eur J Anaesthesiol |volume=34 |issue=9 |pages=571–575 |date=September 2017 |pmid=28731926 |doi=10.1097/EJA.0000000000000638 |s2cid=27536846 }}</ref> A 2011 [[Medical guideline|clinical practice guideline]] supports the use of ketamine as a [[sedative]] in [[emergency medicine]], including during physically painful procedures.<ref name="GreenRoback2011" /> <!-- Ketamine was called a "dissociative" anesthetic because of its effect on electroencephalography (EEG): it caused EEG dissociation between limbic and thalamoneocortical areas.
 -->It is the drug of choice for people in [[traumatic shock]] who are at risk of [[hypotension]].<ref>{{cite web | vauthors = Nickson C |url=http://lifeinthefastlane.com/education/ccc/rapid-sequence-induction-of-the-shock-patient/ |title=Intubation, Hypotension and Shock |publisher=Critical Care Compendium |website=Life in the Fastlane |date=7 August 2013 |access-date=10 April 2014 |type=blog |url-status=dead |archive-url=https://web.archive.org/web/20140209161412/http://lifeinthefastlane.com/education/ccc/rapid-sequence-induction-of-the-shock-patient/ |archive-date=9 February 2014 }}{{unreliable medical source|date=July 2014}}</ref> Ketamine often raises blood pressure upon administration and is unlikely to lower blood pressure in most patients, making it useful in treating severe head injuries for which low blood pressure can be dangerous.<ref>{{cite journal |vauthors=Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L |date=October 2001 |title=Hypotension, hypoxia, and head injury: frequency, duration, and consequences |journal=Archives of Surgery |volume=136 |issue=10 |pages=1118–23 |doi=10.1001/archsurg.136.10.1118 |pmid=11585502 |doi-access=free |title-link=doi}}</ref><ref>{{cite journal | vauthors = Hemmingsen C, Nielsen JE | title = Intravenous ketamine for prevention of severe hypotension during spinal anaesthesia | journal = Acta Anaesthesiologica Scandinavica | volume = 35 | issue = 8 | pages = 755–7 | date = November 1991 | pmid = 1763596 | doi = 10.1111/j.1399-6576.1991.tb03385.x | s2cid = 1324453 }}</ref><ref>{{cite journal | vauthors = Wong DH, Jenkins LC | title = The cardiovascular effects of ketamine in hypotensive states | journal = Canadian Anaesthetists' Society Journal | volume = 22 | issue = 3 | pages = 339–48 | date = May 1975 | pmid = 1139377 | doi = 10.1007/BF03004843 | doi-access = free | title-link = doi }}</ref>

Ketamine is an option in children as the sole anesthetic for minor procedures or as an induction agent followed by [[neuromuscular blocker]] and [[tracheal intubation]].<ref name="pmid25886322">{{cite journal | vauthors = Kurdi MS, Theerth KA, Deva RS | title = Ketamine: Current applications in anesthesia, pain, and critical care | journal = Anesthesia: Essays and Researches | volume = 8 | issue = 3 | pages = 283–90 | date = September 2014 | pmid = 25886322 | pmc = 4258981 | doi = 10.4103/0259-1162.143110 | doi-access = free | title-link = doi }}</ref> In particular, children with [[cyanotic heart disease]] and [[neuromuscular disorders]] are good candidates for ketamine anesthesia.<ref name="pmid32826629">{{cite journal |vauthors=Barrett W, Buxhoeveden M, Dhillon S |title=Ketamine: a versatile tool for anesthesia and analgesia |journal=Current Opinion in Anesthesiology |volume=33 |issue=5 |pages=633–638 |date=October 2020 |pmid=32826629 |doi=10.1097/ACO.0000000000000916 |s2cid=221236545 }}</ref><ref>{{Cite journal |date=2024-04-24 |title=Clinical Uses of Ketamine in Children: A Narrative Review - PMC |pmc=9389002 |journal=Cureus |volume=14 |issue=7 |pages=e27065 |doi=10.7759/cureus.27065 | doi-access = free | title-link = doi |pmid=35989801 | vauthors = Bali A, Dang AK, Gonzalez DA, Kumar R, Asif S }}</ref>

Due to the bronchodilating properties of ketamine, it can be used for anesthesia in people with [[asthma]], [[chronic obstructive airway disease]], and with severe reactive airway disease including active [[bronchospasm]].<ref name="pmid25886322"/><ref name="pmid32826629"/><ref name="Goyal">{{cite journal | vauthors = Goyal S, Agrawal A | title = Ketamine in status asthmaticus: A review | journal = Indian Journal of Critical Care Medicine | volume = 17 | issue = 3 | pages = 154–61 | date = May 2013 | pmid = 24082612 | pmc = 3777369 | doi = 10.4103/0972-5229.117048 | doi-access = free | title-link = doi }}</ref>

=== Pain ===
Ketamine infusions are used for acute pain treatment in emergency departments and in the perioperative period for individuals with refractory or [[intractable pain]]. The doses are lower than those used for anesthesia, usually referred to as sub-anesthetic doses. Adjunctive to [[morphine]] or on its own, ketamine reduces morphine use, pain level, nausea, and vomiting after surgery. Ketamine is likely to be most beneficial for surgical patients when severe post-operative pain is expected, and for opioid-tolerant patients.<ref name="pmid29870457">{{cite journal |vauthors=Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP |title=Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists |journal=Reg Anesth Pain Med |volume=43 |issue=5 |pages=456–466 |date=July 2018 |pmid=29870457 |pmc=6023582 |doi=10.1097/AAP.0000000000000806 }}</ref><ref>{{cite journal | vauthors = Sin B, Ternas T, Motov SM | title = The use of subdissociative-dose ketamine for acute pain in the emergency department | journal = Academic Emergency Medicine | volume = 22 | issue = 3 | pages = 251–7 | date = March 2015 | pmid = 25716117 | doi = 10.1111/acem.12604 | s2cid = 24658476 | doi-access = free | title-link = doi }}</ref>

Ketamine is especially useful in the pre-hospital setting due to its effectiveness and low risk of respiratory depression.<ref name="SvensonBiedermann2011">{{cite journal| vauthors = Svenson J, Biedermann M |title=Ketamine: a unique drug with several potential uses in the prehospital setting|journal=Journal of Paramedic Practice|volume=3|issue=10|year=2011|pages=552–556|doi=10.12968/jpar.2011.3.10.552}}</ref>
Ketamine has similar efficacy to opioids in a hospital emergency department setting for the management of acute pain and the control of procedural pain.<ref name="pmid30019434">{{cite journal | vauthors = Karlow N, Schlaepfer CH, Stoll CR, Doering M, Carpenter CR, Colditz GA, Motov S, Miller J, Schwarz ES | title = A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department | journal = Academic Emergency Medicine | volume = 25 | issue = 10 | pages = 1086–1097 | date = October 2018 | pmid = 30019434 | doi = 10.1111/acem.13502 | doi-access = free | title-link = doi }}</ref> It may also prevent [[opioid-induced hyperalgesia]]<ref name="pmid26495312">{{cite journal | vauthors = Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD | title = Role of ketamine in acute postoperative pain management: a narrative review | journal = BioMed Research International | volume = 2015 | page = 749837 | year = 2015 | pmid = 26495312 | pmc = 4606413 | doi = 10.1155/2015/749837 | doi-access = free | title-link = doi }}</ref><ref name="pmid21412369">{{cite journal | vauthors = Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L | title = A comprehensive review of opioid-induced hyperalgesia | journal = Pain Physician | volume = 14 | issue = 2 | pages = 145–61 | year = 2011 | doi = 10.36076/ppj.2011/14/145 | pmid = 21412369 | doi-access = free | title-link = doi }}</ref> and [[postanesthetic shivering]].<ref>{{cite journal | vauthors = Zhou Y, Mannan A, Han Y, Liu H, Guan HL, Gao X, Dai MS, Cao JL | title = Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis | journal = BMC Anesthesiology | volume = 19 | issue = 1 | page = 245 | date = December 2019 | pmid = 31888509 | pmc = 6937868 | doi = 10.1186/s12871-019-0910-8 | doi-access = free | title-link = doi }}</ref>

For chronic pain, ketamine is used as an intravenous analgesic, mainly if the pain is [[Neuropathic pain|neuropathic]].<ref name="pmid29870458">{{cite journal |vauthors=Cohen SP, Bhatia A, Buvanendran A, Schwenk ES, Wasan AD, Hurley RW, Viscusi ER, Narouze S, Davis FN, Ritchie EC, Lubenow TR, Hooten WM |title=Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists |journal=Reg Anesth Pain Med |volume=43 |issue=5 |pages=521–546 |date=July 2018 |pmid=29870458 |pmc=6023575 |doi=10.1097/AAP.0000000000000808 }}</ref> It has the added benefit of counteracting [[spinal sensitization]] or [[Pain wind-up|wind-up phenomena]] experienced with [[chronic pain]].<ref name="elia">{{cite journal | vauthors = Elia N, Tramèr MR | title = Ketamine and postoperative pain—a quantitative systematic review of randomised trials | journal = Pain | volume = 113 | issue = 1–2 | pages = 61–70 | date = January 2005 | pmid = 15621365 | doi = 10.1016/j.pain.2004.09.036 | s2cid = 25925720 }}</ref> In multiple clinical trials, ketamine infusions delivered short-term pain relief in neuropathic pain diagnoses, pain after a traumatic spine injury, [[fibromyalgia]], and [[complex regional pain syndrome]] (CRPS).<ref name="pmid29870458"/> However, the 2018 consensus guidelines on chronic pain concluded that, overall, there is only weak evidence in favor of ketamine use in spinal injury pain, moderate evidence in favor of ketamine for CRPS, and weak or no evidence for ketamine in mixed neuropathic pain, fibromyalgia, and [[cancer pain]]. In particular, only for CRPS, there is evidence of medium to longer-term pain relief.<ref name="pmid29870458"/>

=== Depression ===
{{See also|Esketamine#Depression|Ketamine-assisted psychotherapy}}

Ketamine is a rapid-acting [[antidepressant]],<ref name="Sachdeva_2023" /> but its effect is transient.<ref name="pmid28249076">{{cite journal | vauthors = Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB | title = A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders | journal = JAMA Psychiatry | volume = 74 | issue = 4 | pages = 399–405 | date = April 2017 | pmid = 28249076 | doi = 10.1001/jamapsychiatry.2017.0080 | s2cid = 28320520 }}</ref> Intravenous ketamine infusion in [[treatment-resistant depression]] may result in improved mood within 4 hours reaching the peak at 24 hours.<ref name=Zhang2018 /><ref name="pmid33065824">{{cite journal |vauthors=Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S |title=A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 – January 2019 |journal=J Affect Disord |volume=277 |pages=831–841 |date=December 2020 |pmid=33065824 |doi=10.1016/j.jad.2020.09.007 |s2cid=223557698 }}</ref> A single dose of intravenous ketamine has been shown to result in a response rate greater than 60% as early as 4.5 hours after the dose (with a sustained effect after 24 hours) and greater than 40% after 7 days.<ref name="pmid29736744"/> Although only a few pilot studies have sought to determine the optimal dose, increasing evidence suggests that 0.5&nbsp;mg/kg dose injected over 40 minutes gives an optimal outcome.<ref name="Sanacora Katz 2018 pp. 243–250">{{cite journal | vauthors = Sanacora G, Katz R | title = Ketamine: A Review for Clinicians | journal = Focus | volume = 16 | issue = 3 | pages = 243–250 | date = July 2018 | pmid = 31975918 | pmc = 6493090 | doi = 10.1176/appi.focus.20180012 | publisher = American Psychiatric Association Publishing }}</ref> The antidepressant effect of ketamine is diminished at 7 days, and most people relapse within 10 days. However, for a significant minority, the improvement may last 30 days or more.<ref name="pmid33065824" /><ref name="pmid33174760">{{cite journal |vauthors=Swainson J, McGirr A, Blier P, Brietzke E, Richard-Devantoy S, Ravindran N, Blier J, Beaulieu S, Frey BN, Kennedy SH, McIntyre RS, Milev RV, Parikh SV, Schaffer A, Taylor VH, Tourjman V, van Ameringen M, Yatham LN, Ravindran AV, Lam RW |title=The Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Recommendations for the Use of Racemic Ketamine in Adults with Major Depressive Disorder: Recommandations Du Groupe De Travail Du Réseau Canadien Pour Les Traitements De L'humeur Et De L'anxiété (Canmat) Concernant L'utilisation De La Kétamine Racémique Chez Les Adultes Souffrant De Trouble Dépressif Majeur |journal=Can J Psychiatry |pages=113–125 |date=November 2020 |volume=66 |issue=2 |pmid=33174760 |doi=10.1177/0706743720970860 |pmc=7918868 }}</ref><ref name="pmid29736744">{{cite journal | vauthors = Molero P, Ramos-Quiroga JA, Martin-Santos R, Calvo-Sánchez E, Gutiérrez-Rojas L, Meana JJ | title = Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review | journal = CNS Drugs | volume = 32 | issue = 5 | pages = 411–420 | date = May 2018 | pmid = 29736744 | doi = 10.1007/s40263-018-0519-3 | s2cid = 13679905 }}</ref><ref name="pmid28395988">{{cite journal | vauthors = Singh I, Morgan C, Curran V, Nutt D, Schlag A, McShane R | title = Ketamine treatment for depression: opportunities for clinical innovation and ethical foresight | journal = The Lancet. Psychiatry | volume = 4 | issue = 5 | pages = 419–426 | date = May 2017 | pmid = 28395988 | doi = 10.1016/S2215-0366(17)30102-5 | url = http://discovery.ucl.ac.uk/1552865/ | hdl-access = free | hdl = 10871/30208 | s2cid = 28186580 | access-date = 10 September 2018 | archive-date = 9 March 2019 | archive-url = https://web.archive.org/web/20190309081101/http://discovery.ucl.ac.uk/1552865/ | url-status = live }}</ref>

One of the main challenges with ketamine treatment can be the length of time that the antidepressant effects last after finishing a course of treatment. A possible option may be maintenance therapy with ketamine, which usually runs twice a week to once in two weeks.<ref name="pmid33065824"/><ref name="pmid33174760"/><ref name="pmid33162856">{{cite journal |vauthors=Bobo WV, Riva-Posse P, Goes FS, Parikh SV |title=Next-Step Treatment Considerations for Patients With Treatment-Resistant Depression That Responds to Low-Dose Intravenous Ketamine |journal=Focus (Am Psychiatr Publ) |volume=18 |issue=2 |pages=181–192 |date=April 2020 |pmid=33162856 |doi=10.1176/appi.focus.20190048 |pmc=7587874 }}</ref> Ketamine may decrease [[suicidal thought]]s for up to three days after the injection.<ref name="pmid31729893">{{cite journal |vauthors=Witt K, Potts J, Hubers A, Grunebaum MF, Murrough JW, Loo C, Cipriani A, Hawton K |title=Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials |journal=Aust N Z J Psychiatry |volume=54 |issue=1 |pages=29–45 |date=January 2020 |pmid=31729893 |doi=10.1177/0004867419883341 |s2cid=208035394 |url=https://ora.ox.ac.uk/objects/uuid:25219d6c-5c8f-4842-91d9-41a9fd7fb1bd |access-date=18 January 2021 |archive-date=2 July 2022 |archive-url=https://web.archive.org/web/20220702024708/https://ora.ox.ac.uk/objects/uuid:25219d6c-5c8f-4842-91d9-41a9fd7fb1bd |url-status=live |hdl=1959.4/unsworks_76229 |hdl-access=free }}</ref>

An [[enantiomer]] of ketamine {{ndash}} [[esketamine]] {{ndash}} was approved as an antidepressant by the [[European Medicines Agency]] in 2019.<ref>{{cite web|title=Spravato (esketamine)|publisher=European Medicines Agency|date=8 July 2022|accessdate=20 July 2022|url=https://www.ema.europa.eu/en/medicines/human/EPAR/spravato|archive-date=23 November 2020|archive-url=https://web.archive.org/web/20201123231245/https://www.ema.europa.eu/en/medicines/human/EPAR/spravato|url-status=live}}</ref> Esketamine was approved as a nasal spray for treatment-resistant depression in the United States<ref name="fda-spravato">{{cite web |title=FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor's office or clinic |url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified |publisher=US Food and Drug Administration |access-date=29 July 2022 |date=5 March 2019 |archive-date=23 July 2021 |archive-url=https://web.archive.org/web/20210723022112/https://www.fda.gov/news-events/press-announcements/fda-approves-new-nasal-spray-medication-treatment-resistant-depression-available-only-certified |url-status=live }}</ref> and elsewhere in 2019. The Canadian Network for Mood and Anxiety Treatments (CANMAT) recommends esketamine as a third-line treatment for depression.<ref name="pmid33174760"/>

A [[Cochrane (organisation)|Cochrane review]] of [[randomized controlled trial]]s in adults with [[major depressive disorder]]<ref name="Sachdeva_2023" /> found that when compared with placebo, people treated with either ketamine or esketamine experienced reduction or remission of symptoms lasting 1 to 7 days.<ref name="dean2">{{cite journal | vauthors = Dean RL, Hurducas C, Hawton K, Spyridi S, Cowen PJ, Hollingsworth S, Marquardt T, Barnes A, Smith R, McShane R, Turner EH, Cipriani A| title = Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder | journal = The Cochrane Database of Systematic Reviews | volume = 9 | pages = CD011612 | date = September 2021 | issue = 11 | pmid = 34510411 | pmc = 8434915 | doi = 10.1002/14651858.CD011612.pub3 }}</ref> There were 18.7% (4.1 to 40.4%) more people reporting some benefit and 9.6% (0.2 to 39.4%) more who achieved remission within 24 hours of ketamine treatment. Among people receiving esketamine, 12.1% (2.5 to 24.4%) encountered some relief at 24 hours, and 10.3% (4.5 to 18.2%) had few or no symptoms. These effects did not persist beyond one week, although a higher dropout rate in some studies means that the benefit duration remains unclear.<ref name=dean2/>

Ketamine may partially improve depressive symptoms<ref name="Sachdeva_2023" /> among people with [[bipolar depression]] at 24 hours after treatment, but not three or more days.<ref name="dean">{{cite journal | vauthors = Dean RL, Marquardt T, Hurducas C, Spyridi S, Barnes A, Smith R, Cowen PJ, McShane R, Hawton K, Malhi GS, Geddes J, Cipriani A | title = Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | pages = CD011611 | date = October 2021 | issue = 10 | pmid = 34623633 | pmc = 8499740 | doi = 10.1002/14651858.CD011611.pub3 }}</ref> Potentially, ten more people with bipolar depression per 1000 may experience brief improvement, but not the cessation of symptoms, one day following treatment. These estimates are based on limited available research.<ref name=dean/>

In February 2022, the US [[Food and Drug Administration]] (FDA) issued an alert to healthcare professionals concerning [[compounding|compounded]] nasal spray products containing ketamine intended to treat depression.<ref name="fda-2/22">{{cite web |title=FDA alerts health care professionals of potential risks associated with compounded ketamine nasal spray |url=https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-professionals-potential-risks-associated-compounded-ketamine-nasal-spray |publisher=US Food and Drug Administration |access-date=29 July 2022 |date=16 February 2022 |archive-date=31 August 2022 |archive-url=https://web.archive.org/web/20220831210903/https://www.fda.gov/drugs/human-drug-compounding/fda-alerts-health-care-professionals-potential-risks-associated-compounded-ketamine-nasal-spray |url-status=live }}</ref>

===Seizures===
Ketamine is used to treat [[status epilepticus]]<ref name="pmid33923061">{{cite journal | vauthors = Ghosh S, Sinha JK, Khan T, Devaraju KS, Singh P, Vaibhav K, Gaur P | title = Pharmacological and Therapeutic Approaches in the Treatment of Epilepsy | journal = Biomedicines | volume = 9 | issue = 5 | date = April 2021 | page = 470 | pmid = 33923061 | pmc = 8146518 | doi = 10.3390/biomedicines9050470 | doi-access = free | title-link = doi }}</ref> that has not responded to standard treatments, but only case studies and no randomized controlled trials support its use.<ref>{{cite journal | vauthors = Gomes D, Pimentel J, Bentes C, Aguiar de Sousa D, Antunes AP, Alvarez A, Silva ZC | title = Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus | journal = Acta Médica Portuguesa | volume = 31 | issue = 10 | pages = 598–605 | date = October 2018 | pmid = 30387431 | doi = 10.20344/amp.9679 | url = https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/9679 | doi-access = free | title-link = doi | access-date = 11 February 2020 | archive-date = 29 August 2020 | archive-url = https://web.archive.org/web/20200829074412/https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/9679 | url-status = live }}</ref><ref name="pmid30232735">{{cite journal |vauthors=Rosati A, De Masi S, Guerrini R |title=Ketamine for Refractory Status Epilepticus: A Systematic Review |journal=CNS Drugs |volume=32 |issue=11 |pages=997–1009 |date=November 2018 |pmid=30232735 |doi=10.1007/s40263-018-0569-6 |s2cid=52302073 }}</ref>

===Asthma===
Ketamine has been suggested as a possible therapy for children with severe acute asthma who do not respond to standard treatment.<ref name="Jat_2012">{{cite journal | vauthors = Jat KR, Chawla D | title = Ketamine for management of acute exacerbations of asthma in children | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD009293 | date = November 2012 | pmid = 23152273 | pmc = 6483733 | doi = 10.1002/14651858.CD009293.pub2 | collaboration = Cochrane Airways Group }}</ref> This is due to its [[bronchodilator]] effects.<ref name="Jat_2012" /> A 2012 Cochrane review found there were minimal adverse effects reported, but the limited studies showed no significant benefit.<ref name="Jat_2012" />