The ketamine business in this country has topped five billion dollars and the boom in sales of this powerful anesthetic is alarming anesthesiologists who warn that access to ketamine is expanding faster than safety standards. The American Society of Anesthesiologists says there are three key safety concerns about the expanded availability of ketamine. One is that ketamine can slow or stop breathing at higher doses than safe. Another is the drug can cause sudden and dangerous increases in blood pressure and heart rate. Third is the worry that ketamine may be misused, shared or illegally resold. The organization calls for appropriate monitoring and medical supervision of ketamine.