The management of the uncooperative pediatric patient undergoing minor surgical procedures has always been a great challenge. Several sedative techniques are available that will effectively alleviate anxiety, but short of general anesthesia, no sedative regimen is available that will enable treatment of the uncooperative child. Ketamine produces a unique anesthetic state, dissociative anesthesia, which safely and effectively enables treatment of these children. The pharmacology, proposed mechanisms of action, and clinical use of ketamine (alone and in combination with other agents) are reviewed and evaluated.