Ketamine is a widely used anesthetic and analgesic agent in Ghana, valued for its effectiveness, affordability, and ease of administration, particularly in resource-limited settings. Despite its essential role in surgical and procedural care, concerns have grown regarding unsafe use, especially in rural clinics and smaller healthcare facilities where adherence to administration protocols, provider training, and post-use monitoring is often inconsistent. Such lapses pose significant risks to patient safety and highlight gaps in oversight and regulation. The rising national surgical volume—over a 65% increase since 2010—underscores the critical need for safe anesthesia access across all healthcare facilities, irrespective of specialist availability. This study examines the current patterns of ketamine use in Ghana, identifying both the benefits of its widespread accessibility and the challenges posed by limited regulatory frameworks. It explores strategies to establish a balance between maintaining ketamine availability for patients in need and implementing evidence-based, accountable practices to mitigate risks. Effective management of ketamine use requires a coordinated approach involving healthcare regulatory agencies, local facilities, academic research institutions, and equipment manufacturers. Regulatory bodies must develop and enforce comprehensive guidelines on administration, training, and monitoring, while healthcare providers implement these standards in everyday clinical practice. Academic research can further inform policy by evaluating usage patterns, adverse events, and patient outcomes over representative timeframes. Additionally, technological solutions and monitoring devices can support safe administration, particularly in under-resourced areas. This study emphasizes the imperative of a multifaceted, collaborative approach to ketamine governance, highlighting how careful regulation combined with continued access can optimize patient safety while preserving the benefits of this critical anesthetic. The findings support the development of policy frameworks that safeguard public health without compromising clinical utility, ensuring that ketamine continues to play a vital role in Ghana’s evolving healthcare system.