Ketamine is an NMDA-receptor antagonist that possesses intrinsic sympathomimetic activity. This effect is probably central in origin, although the precise mechanism is poorly understood.
This sympathomimetic effect could increase myocardial oxygen demand and consumption. In a patient with pheochromocytoma this is especially undesirable, and could exacerbate pre-existing hypertension, precipitate congestive heart failure, cause myocardial ischemia, or even lead to life-threatening intracranial hemorrhage.
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