In which group of patients is ketamine relatively contraindicated despite its favourable haemodynamic profile?

• A Children undergoing painful dressing changes
• B Patients with bronchospastic airway disease
• C Patients with right-to-left cardiac shunts requiring increased pulmonary vascular resistance
• D Patients with ischaemic heart disease and fixed coronary stenosis ✓

Explanation

Ketamine raises heart rate, blood pressure and myocardial oxygen demand through central sympathetic stimulation. In a patient whose coronary supply cannot rise to match this demand, such as significant fixed stenosis, ketamine risks worsening ischaemia, so it is relatively avoided. Bronchospasm favours ketamine, children tolerate it well, and its ability to raise pulmonary vascular resistance matters in shunts where it would be harmful rather than protective.

Reference: Stoelting's Pharmacology and Physiology in Anesthetic Practice, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.