[Current aspects of using ketamine in childhood]

Ketamine is still a relatively seldom-used anaesthetic because of its psychotomimetic and sympathomimetic side-effects and because ketamine anaesthesia is poorly controllable. At present, the enantiomer S-(+)-ketamine (Ketanest S) is clinically used. During its application, a twofold higher pharmacologic potency and a faster elimination can be expected than with the racemic-ketamine mixture. Particularly in paediatric anaesthesia, no practical experience could be gained with this new drug. Form the current standpoint, an overview is given of the possible applications of ketamine in children regarding premedication and early induction of ketamine anaesthesia in combination with midazolam because ketamine can be inserted through the nose or rectum and it can also be applied orally or intramuscularly. Ketamine widens the anaesthetist's possibilities of premedication considerably and thus a calm induction of anaesthesia with stabilized spontaneous ventilation becomes possible in children with difficult conditions for venous puncturing, in very anxious children and in those who are not able to accept the necessity of treatment. The use of ketamine for the performance of small operations, for analgosedation during diagnostic procedures, for induction of anaesthesia in children with unstable haemodynamic conditions and with cardiac defects connected with reduced lung perfusion and for analgosedation in intensive care, in particular in patients with obstructive ventilation disturbances and diseases which need a therapy with catecholamines, is discussed. To avoid complications, the children should be supervised constantly during the application of ketamine. It should be used only in low doses and any combination with centrally depressive-acting drugs--with the exception of midazolam--should be avoided. During analgosedation with ketamine and midazolam in intensive care, the anaesthetist must be aware of a cumulative effect in particular in those children with liver and kidney insufficiencies. Analgosedation with ketamine and propofol can be better controlled horizontally and therefore, this combination should be taken more into consideration in children with the exception of those with diseases of inflammatory and septic genesis.