Background and aims Ketamine is an efficient, economical dissociative sedative used during painful procedures as an alternative to general anaesthesia. Its physiological risk profile has been thoroughly researched; however, less well understood are the psychological events (“emergence phenomena”) associated with its use. In adult practice, ketamine use is declining given the traumatic effects of emergence phenomena on patients, family, and staff. In paediatric practice, however, ketamine use is increasing despite a limited understanding of the occurrence of paediatric emergence phenomena and it’s associated potential for non-physiological harm. This study analyses the ethical implications of paediatric ketamine sedation by exploring healthcare practitioners’ (HCPs’) accounts of paediatric emergence phenomena.

Methods HCPs (doctors, nurses, paramedics, and a play specialist) were interviewed about their experiences with emergence phenomena during paediatric ketamine sedation. Interviews were then analysed using a descriptive exploratory approach underpinned by hermeneutic narrative methods to identify common themes.

Results A focus on physiological risk has resulted in a trial-and-error approach to paediatric ketamine sedation practice. Understandings of non-physiological or psychological risk and the potential negative longitudinal outcomes in paediatric populations remain vague. “Dream seeding” (guided imagery) is widely yet inconsistently used as an anxiolytic for reducing negative psychotropic events, despite only anecdotal evidence of its effectiveness.

Conclusions Although ketamine sedation can help protect children from the pain of treatment and HCPs from emotional distress of delivering that treatment, there is potential for non-physiological harm. The practice of dream seeding should be investigated as a tool to mitigate adverse psychotropic events.