Ketamine's dual role as a neuroprotective and anti-inflammatory agent in pediatric emergencies: Pharmacological reappraisal

Ketamine has been widely used in pediatric emergency medicine for procedural sedation and pain control. However, growing evidence suggested it possesses significant neuroprotective and anti-inflammatory properties that extend well beyond its traditional applications. This narrative review examined ketamine\'s pharmacological mechanisms and clinical utility in pediatric emergencies, with particular emphasis on its role in conditions such as status epilepticus, traumatic brain injury, severe asthma, and sickle cell crisis. This review aimed to explore how ketamine\'s N-methyl-D-aspartate receptor antagonism protected against excitotoxicity while modulating inflammatory pathways. The drug demonstrates hemodynamic stability, rapid onset, and versatility across multiple administration routes. Compared to conventional agents, ketamine offers superior safety profiles in critically ill children, particularly in resource-constrained settings common throughout the Middle East. While further studies are needed to establish optimal dosing protocols and assess long-term outcomes, current evidence strongly supports expanding ketamine\'s role beyond sedation to address the complex pathophysiology of pediatric emergencies. This review integrated experimental data, pharmacological insights, and clinical trial results to provide emergency medicine practitioners with an updated understanding of ketamine\'s therapeutic potential in critically ill children.