We evaluated the use of ketamine as sole anesthetic agent for open liver biopsy, with particular reference to its effect on liver function and hepatotoxicity and its effect on cardiovascular stability and respiration. From 386 patients who underwent liver biopsy at Jordan University Hospital, 12 had open liver biopsy because of contra-indications for closed needle biopsy. The surgical procedure consisted of a small right paramedian incision allowing inspection of the liver surface and a wedge and needle biopsy. Ketamine HCl was used in a dose of 2 mg/kg I.V. with supplemental doses as necessary. No significant fluctuations in cardio-respiratory vital signs were observed. Muscle rigidity and respiratory tagging movements necessitated addition of a muscle relaxant and artificial ventilation in three patients. Six patients reported dreams, two of which were described as nightmares. There was no liver function decompensation, or significant bilirubin or transaminase elevations in the week following the biopsy. Ketamine is a safe anesthetic to use for open liver biopsy in patients with underlying liver disease, although poor muscle relaxation and nightmares may be significant side effects.