Response by Uday Jain, M.D.

My article on anesthesia for disasters and austere environments was restricted to 1,500 words. Ketamine was a very small part of it, and there was insufficient space to discuss it in detail. Drs. Kakazu and Lippmann state that “Many anesthesiologists and surgeons feel that ketamine always performs in a ‘positive’ way to improve or at least maintain a patient’s hemodynamic profile.” There is no basis for this statement. Actually, all “anesthesiologists and surgeons” know that no drug “always performs in a ‘positive’ way.” Anesthesiologists know that in traumatized patients, any anesthetic can cause hypotension and should be used with caution and in small, divided doses or by infusion. The common side effects of benzodiazepines are also well known to anesthesiologists and could not be elaborated in my article because of lack of space. Drs. Kakazu and Lippmann caution against the use of ketamine in “the severely septic patient.” My article...