Ketamine intramuscularly for total dentistry in uncooperative, unmanageable, ambulatory children.

Ketamine introduced in 19651,2 has now been established as a safe, effective anesthetic agent, and its utility has been confirmed in a variety of surgical and diagnostic applications.3'4'5 It is unique in that it can safely subdue the most unmanageable, irrational, uncooperative patient by a simple intramuscular injection. Ketamine is a phencycidine derivative which can be administered intravenously or intramuscularly. It is a nonbarbiturate, and the only drug available today which can be used safely as an anesthetic when injected intramuscularly without adversely affecting the respiratory or cardiovascular systems. It is the only drug available which preserves the oropharyngeal reflexes even at its greatest depth of action. Although completely anesthetized, the patient usually does not require chin support or tongue retraction by an oropharyngeal airway to maintain the integrity of the airway. This unique characteristic is ideally suited to dentistry. The disadvantage of Ketamine in an ambulatory dental office practice is the fact that patients are rendered unambulatory for a period of 2 to 3 hours after the last intramuscular or intravenous injection of the drug. Although an average patient will obey commands 30 to 40 minutes after receiving an intramuscular dose (20 to 30 minutes after an intravenous dose), it usually requires 2 to 3 hours before the patient can stand on his feet without external support. If ambulation is attempted too quickly, nausea and vomiting frequently ensue. Another serious disadvantage in using the drug in the dental office on adults is the frequency with which dreams of an un-