Who should not receive ketamine?

• A. Adults with hypertension
• B. Kids
• C. Elderly
• D. Patients with asthma

Answer: (B)

Ketamine is a dissociative anesthetic that preserves airway reflexes and respiration, and it’s valued for rapid sedation and analgesia in emergencies. However, it can cause emergence phenomena (agitation, dreams) and autonomic effects like increased heart rate and blood pressure. In pediatric patients, emergence delirium is more common and can complicate airway management and transport, especially in a prehospital/flight setting where monitoring and dosing are more challenging. For that reason, pediatric patients are the group where ketamine is avoided or used with great caution in this context.

In contrast, adults with hypertension may experience higher blood pressure with ketamine but it’s not an absolute contraindication and can be used with careful monitoring. In the elderly, there is increased sensitivity to CNS and cardiovascular effects, so caution is advised, but it’s not an outright prohibition. Patients with asthma can actually benefit from ketamine’s bronchodilatory properties, so it’s not contraindicated there.

So, the most appropriate group not to receive ketamine in this scenario is kids.