American Society of Anesthesiologists shares guidance for safe nonanesthetic ketamine use

Key takeaways:

• The guidance was issued amid a rise in ketamine use for the treatment of PTSD, depression and other mood disorders.
• Inappropriate and uneducated ketamine use can lead to life-threatening side effects.

The American Society of Anesthesiologists released new guidance on the safe use of ketamine for nonanesthesia purposes, such as the treatment of mental health disorders, according to an organization press release.

The guidelines emphasize that ketamine should be prescribed following the same principles used for other sedating medications, and as part of a comprehensive treatment plan.

“Anesthesiologists have been administering ketamine as a sedative and anesthetic drug for decades,” Ronald L. Harter, MD, FASA, immediate past president of the American Society of Anesthesiologists (ASA), told Healio in an interview. “As the medical specialty that has the longest and most extensive experience with ketamine, we felt that we could contribute further to the existing guidance on how to administer it safely and appropriately.”

In addition to highlighting the importance of following the same general prescribing principles as other sedating medications for the nonanesthetic administration of ketamine, the ASA’s guidance emphasizes that patients should be educated on the potentially life-threatening side effects of using the drug.

“In the aftermath of Matthew Perry’s unfortunate demise, the media was flooded with supposed experts saying things about ketamine that were dangerous and simply not true, such as that you can’t overdose on ketamine,” Harter said. “Ketamine is a potent anesthetic drug, and you absolutely can overdose on it.”

The organization also emphasized that ketamine should only be administered in a monitored setting under the care and supervision of trained medical personnel.

“We’ve become aware that there are some places in the country where people can have ketamine sent to their homes; for those of us who know how potent of a drug ketamine is, the proposition that somebody could be administering it at home is scary,” Harter told Healio. “The most significant concerns are that you can get respiratory depression at the higher end of dosage, but also, as with any drug, it can interact with other medications. Additionally, we’ve known for a long time that ketamine can cause somewhat disturbing and dangerous hallucinations, which is another reason why being in a safe and monitored setting is appropriate.”

Other recommendations from the ASA guidance included:

• only prescribing ketamine for a medical indication as part of a comprehensive treatment plan that includes periodic face-to-face visits with the patient;
• identifying a therapeutic endpoint and defined treatment course for ketamine use;
• prescribing ketamine at the minimum dose necessary to achieve a desired clinical effect; and
• ensuring that patients are using ketamine as prescribed.

“As the knowledge and science evolves, I would imagine that we may make some further adjustment and refinement to this, but the main message we wanted to get out is that this is a potent drug with potentially significant side effects and it’s not something that should be given in an unmonitored, nonmedical setting, whether that is your home, a friend’s house or whatever the case may be,” Harter said.

Reference:

• Ketamine for mental health should only be provided by trained professionals. https://www.asahq.org/about-asa/newsroom/news-releases/2025/02/ketamine-for-mental-health. Published Feb. 11, 2025. Accessed Feb. 21, 2025.