What safety standards should apply when ketamine is used outside the operating room?

Reviewed by Russell McAllister, MD, FASA on October 23, 2026

Ketamine should be administered within a care system that provides appropriate patient selection, dosing, monitoring, trained personnel, and immediate access to emergency airway and resuscitation equipment. The necessary safeguards depend on the dose, patient’s condition, and other patient medications.

Ketamine is a useful medical drug, but it can also affect breathing, blood pressure, awareness, and the ability to respond to danger. When ketamine is given by injection or infusion outside an operating room, clinics need properly trained staff, appropriate monitoring, emergency equipment, a plan for recovery, and a physician who is accountable for medical decisions.

Quick Summary

Texas is actively defining safeguards: In 2026, the Texas Medical Board proposed rules for ketamine given by injection or infusion, including clinic registration, physician medical-director responsibilities, informed consent, patient monitoring, staffing limits, observation after treatment, reporting of serious events, and inspections.
Why the indication does not eliminate anesthesia risk: The same drug can affect a patient whether it is given for surgery, pain, or a mental-health condition.
TSA policy position: TSA supports clear physician responsibility, monitoring suited to the medication and patient, trained staff and appropriate staffing levels, equipment to manage an emergency, a safe recovery and discharge plan, and reporting when serious problems occur.

Texas is actively defining safeguards

In 2026, the Texas Medical Board proposed rules for ketamine given by injection or infusion, including clinic registration, physician medical-director responsibilities, informed consent, patient monitoring, staffing limits, observation after treatment, reporting of serious events, and inspections. These are proposed safeguards and should not be described as already effective requirements unless adopted.

Why the indication does not eliminate anesthesia risk

The same drug can affect a patient whether it is given for surgery, pain, or a mental-health condition. Ketamine may alter a patient’s level of awareness, breathing, blood pressure, or heart rate. Legislators should ask a simple question: if a patient stops breathing or has another emergency, can the staff recognize and treat it immediately?

TSA policy position

TSA supports clear physician responsibility, monitoring suited to the medication and patient, trained staff and appropriate staffing levels, equipment to manage an emergency, a safe recovery and discharge plan, and reporting when serious problems occur.

Outside resources

FDA — Drug Safety Communications

Sources

Reviewed By

Physician reviewer:: Russell McAllister, MD, FASA Verify certification and MOCA status (opens in a new tab)
Board certification:: Anesthesiology — American Board of Anesthesiology (ABA)
Additional reviewer:: Jeremie J. Perry, MD, FASA
Last reviewed:: October 23, 2026