KETAMINE has always been the odd one out. Like an eccentric uncle who always turns up at the holiday season with a new partner, ketamine has never really comfortably fitted in to simple classifications of anesthetic drugs. Obviously, the anesthesia produced by ketamine is qualitatively very different, as compared to the more traditional γ-aminobutyric acid–mediated (GABAergic) hypnotics. Despite clear cardiopulmonary advantages (i.e., minimal hypotension or hypoventilation), its use has waxed and waned for the past 50 yr, due to concerns over postanesthetic neurocognitive behaviors.

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