Has anyone ever had to be taken to the hospital from your clinic?

We are equipped and trained to escalate to emergency services when an event is beyond the scope of office-based care, and we follow AANA office-based anesthesia standards that require that capability. Rather than claim a perfect record, we will say this: our protocols, equipment, and training exist precisely so that an in-clinic transfer decision can be made quickly and correctly when one is ever needed.

What is the most common thing that actually happens during a session?

By a wide margin, transient blood pressure elevation. It is expected, almost always self-limited, and tracked continuously throughout the infusion. Mild nausea and lingering dissociative feelings beyond the typical recovery window are next most common. Marla Peterson, CRNA, oversees every infusion and adjusts in real time. You can read more about that in our article on what Marla does during an infusion.

Will you call my psychiatrist or prescriber if something happens?

With your written consent, yes. We document the event and communicate directly with your referring or treating provider so your full care team is on the same page. If you have not already given consent for that contact, we will ask you to do so before reaching out.

Do you keep treating me if I have an adverse event?

It depends on what happened. Sometimes we adjust dose, slow the infusion, or pre-medicate for the next session. Sometimes we pause and order additional workup. Sometimes we decide together that ketamine is not the right tool and we decline further sessions. The decision is collaborative and conservative.

What if I have a delayed reaction at home that night?

Call us at (615) 988-4600. We have post-session contact protocols and can talk through what you are experiencing. For symptoms that feel urgent — chest pain, severe shortness of breath, fainting, signs of a stroke, or thoughts of harming yourself — go to the nearest emergency room or call 911 first, then let us know so we can coordinate follow-up.

How We Handle Adverse Events During and After Ketamine Therapy

Why this article exists — transparency is part of the standard of care

If you are reading this before a first infusion, the question on your mind is probably some version of what happens if something goes wrong? That question deserves a real answer rather than reassurance. Ketamine is FDA-approved as an anesthetic; its use for depression, anxiety, PTSD, and chronic pain conditions is off-label, and any honest description of office-based ketamine has to include what the response looks like when an event occurs.

The clinical literature distinguishes between expected reactions, uncommon reactions, and serious adverse events. Each category has a different protocol. We follow written protocols based on the American Association of Nurse Anesthesiology (AANA) Standards for Office-Based Anesthesia Practice (2020), which require an anesthesia provider trained in ACLS and airway management, immediately available emergency medications and equipment, and documented incident review. Our post-session reporting and follow-up follows the ASKP3 Standards of Care for Ketamine Therapy (2024), which call for vital-sign monitoring throughout administration and structured communication with the patient and referring providers.

Common, expected reactions vs. true adverse events

Not every uncomfortable moment during a ketamine session is an adverse event. Several reactions are expected effects of the medication and resolve on their own.

Transient blood-pressure elevation. Ketamine reliably raises systolic and diastolic pressure by 15–30%. It is expected. We watch the trend, not just a single number, and we know what range is acceptable for each individual patient.
Dissociation. The therapeutic dissociative state — floating, time distortion, perceptual shifts — is the medication doing what it is supposed to do. Discomfort with that state is not the same thing as an adverse event. You can read more in our piece on whether ketamine causes flashbacks.
Mild nausea. Common, easily pre-treated, and almost always resolves before discharge.

Uncommon reactions include persistent nausea or vomiting that does not respond to first-line anti-nausea medication, prolonged dissociation that extends well beyond the typical 20-to-40-minute recovery window, headache that lasts past the session, and a brief emergence reaction — vivid confusion or anxiety as the patient surfaces from the dissociative state. These usually need active management but are not, by themselves, dangerous.

True adverse events are rarer. The FDA’s 2023 Drug Safety Communication on compounded ketamine names the categories we plan for: clinically significant blood-pressure elevation, sedation, respiratory depression, dissociation that does not resolve, psychiatric worsening, and urinary tract symptoms. We monitor for each.

What happens in the moment: BP spike, emergence reaction, nausea

Continuous monitoring is the foundation. Every patient is on continuous pulse oximetry, blood-pressure cycling at fixed intervals (more frequently if a trend warrants it), and heart-rate tracking. The room is set up so that the medication, the monitor, the airway equipment, and the IV are all within arm’s reach.

A meaningful blood-pressure spike — one that crosses the threshold we’ve set for that patient — gets a stepwise response: slow or pause the infusion, recheck, treat with an antihypertensive if needed, document, and decide whether the session continues. We discuss this in detail in our note on ketamine and hypertension and in the related piece on ketamine and heart conditions. The threshold is set before the IV is started, not in the middle of the event.

An emergence reaction at the end of the session is managed with a quiet room, lower stimulation, verbal grounding, and, when appropriate, a small dose of a benzodiazepine consistent with our written protocol. Most resolve within minutes. We do not rush patients out of the recliner.

Persistent nausea is treated with the next-line antiemetic. We do not discharge anyone who is still actively nauseous.

Rare but serious: arrhythmia, prolonged dissociation, psychiatric worsening

Serious adverse events — the ones that require escalation beyond office-based care — are uncommon in well-screened outpatient ketamine populations, but no clinic that says otherwise is being honest. The categories we plan for include cardiac arrhythmia, an allergic-type reaction, respiratory depression, dissociation that does not resolve in the expected window, and acute psychiatric worsening (including new or intensifying suicidal thoughts).

For each, we have a written protocol. For each, the equipment and medications required to begin treatment are in the room before the infusion starts. For each, the decision tree includes when do we stop trying to manage this in clinic and call 911. The AANA standards we follow require exactly that planning. The point of writing it down in advance is so the in-the-moment decision is structural, not improvised.

What Marla and the team are trained to do

Marla Peterson, CRNA, is an anesthesia provider trained in ACLS and airway management, and she oversees every infusion. The CRNA-led model is what makes office-based ketamine safer than office-based ketamine without an anesthesia provider: the in-room clinician already has the skill set required to recognize the deterioration patterns the AANA standards are written around. You can read more about the in-session role in our article on what Marla does during an infusion.

Beyond the CRNA, the rest of the team is trained on the same written protocols, conducts periodic emergency drills, and maintains the emergency medication and airway carts on a checked schedule. None of this is unique to ketamine — it is the same approach any well-run office-based anesthesia practice takes. It is, however, the floor below which we will not operate.

How we communicate with you and your prescriber after an event

If something happens during a session, you will know. We tell you what we observed, what we did, and what it means. Patients are not informed about their own care after the fact in our practice.

With your written consent, we contact your referring provider, psychiatrist, primary care doctor, or pain physician — whoever is part of your treating team — and document the event in writing. The ASKP3 Standards of Care call for structured communication with the patient and referring providers, and that is the workflow we follow. The intent is to keep your full care team aligned so that decisions about your other medications or treatments are made with complete information, not in a vacuum.

For events that meet reporting criteria, we file with the FDA’s MedWatch adverse-event reporting system. MedWatch exists for exactly this purpose: a national, voluntary system for clinicians to report serious adverse events involving medications. Reporting is part of how the broader evidence base on outpatient ketamine continues to mature.

Follow-up: when we call, when we adjust, when we stop

After any event, we follow up. The format depends on the event — sometimes a phone call within 24 hours, sometimes an additional clinic visit, sometimes a written symptom check-in over several days. The point is that the follow-up is structured, not left to whether the patient remembers to call.

What happens next varies:

We adjust. A different premedication, a slower infusion rate, a lower starting dose, or an earlier blood-pressure threshold for the next session.
We pause. We hold off on additional sessions while a workup is completed — cardiology evaluation after a cardiac event, psychiatric evaluation after a sustained mood worsening, urology evaluation if a urinary symptom emerges and persists.
We stop. Sometimes the right answer is that ketamine is not the right tool for this patient at this time. Our piece on when we decline ketamine for a patient describes the criteria we use.

Discharge from any session, event or no event, is governed by objective criteria. Vital signs must be at baseline, the patient must be ambulatory and oriented, nausea must be controlled, and a sober adult driver must be present. The full list is in our note on discharge criteria after ketamine therapy.

Documentation, internal review, and how we improve

Every session is documented in the medical record. Every event — minor or major — is documented in an incident-tracking process separate from the routine session note. The AANA standards require a documented incident review process; ours includes a structured debrief and, for any serious event, a formal review of whether the protocol was followed and whether the protocol itself needs to change.

That feedback loop is the difference between writing protocols and actually using them. A clinic that never updates its written procedures is either not seeing events or not learning from them. We treat documentation as a clinical instrument, not as paperwork.

Cost is sometimes part of the conversation after an event — for example, when a patient is weighing whether to continue at a different dose or schedule. Our standard session cost is described in our ketamine therapy cost note ($475 per session at the time of this writing). We do not charge differently because of an event, and we do not invent prices in the middle of a treatment plan.

Two final points. First, ketamine’s use for psychiatric and chronic pain conditions is off-label; that fact does not change the clinical standards we apply, but it does mean every patient deserves to know what the evidence base does and does not yet support. Second, never start, stop, or change any medication without talking to your prescribing provider — that includes after a session, even if something we did or said feels like a reason to do so.