Ketamine is an old drug, but a good drug. Patients often complain it makes them feel nasty but it greatly relieves pain without having negative effects on blood pressure and heart rate, and does NOT cause respiratory depression. This can be critical when you're dealing with trauma. When you have a bad fracture-dislocation (such as an ankle F-D) you need to get it reduced asap to restore circulation and to prevent nerve damage. Ketamine gives docs the ability to do that. Most of the drugs we have historically used to reduce fractures/ dislocations in the ER produce one or all of these negative effects, but ketamine gives us a fast "out" when we need it. .
Yep, it has some real advantages used even solo in certain situations, and some more when a couple additional drugs are added; however, what you describe is why it fell out of general use for quite a while in anesthesia practices with the exception of very young children who didn’t seem to get the dysphoric reactions. It’s come back a bit into favor again because research showed very small doses would affect the brain reducing the perception of some kinds of post-surgical pain.
And what D Roc mentioned above about good analgesia with cardiovascular support, something the narcotics don’t do is a huge advantage in many cases. It’s not a narco- but classified as dissociative drug.
