C/I of ketamine- Pts with inc icp Open eye injury or other ophthalmic injury c/I as sole anaesthetic agent in ischemic heart disease pts with vascular aneurysm* psychiatric disorder like schizophrenia h/o adverse reaction to ketamine

↑BP, ↑HR , ↑ CO in a biphasic manner

It s direct cardiodepressant * effect occurs next to indirect stimulatory effect (sec to activation of sympathetic system)

↑ SBP is 20 to 40 mm Hg, with a slightly increase in DBP, increases progressively during the first 3 to 5 minutes after an intravenous injection of ketamine and then decreases to predrug levels over the next 10 to 20 minutes.

↑ myocardial O2 demand – provided by adequate CO &↓ coronary vascular resistance .

These effect are more apparent in 1 st bolus dose than 2 nd dose .

Ketamine ↑ pul artery pressure – caution use in left side stenoticvalvular lesion .

Tachycardia and hypertension by ketamine can be prevented by continuos low dose infusion,premedication with BZD or with inhalational agent or propofol.

Cautiously use in IHD