What is the role of ketamine in the treatment of status asthmaticus?

Updated: Jun 17, 2020
  • Author: Constantine K Saadeh, MD; Chief Editor: John J Oppenheimer, MD  more...
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Ketamine is a short-acting pentachlorophenol derivative that exerts bronchodilatory effects because it leads to an increase in endogenous catecholamine levels, which may bind to beta receptors and cause smooth muscle relaxation and bronchodilation.

Ketamine was used in the management of status asthmaticus in a prospective trial in patients with respiratory failure who did not respond adequately to mechanical ventilation. [42] This agent improved airway resistance, particularly the lower airways, as well as improve lung compliance. Significant improvement in oxygenation and hypercarbia has been reported, even 15 minutes after the administration of ketamine.

Case reports have also described the use of ketamine as a sedative to reduce anxiety and agitation that can exacerbate tachypnea and work of breathing and potentially obviate further respiratory failure in small children with status asthmaticus.

Ketamine as a continuous infusion may induce relaxation of the airways with limited anesthesia. However, its role is still limited in status asthmaticus. Central nervous system sedation, which may require intubation, is a limitation in its use. It is also noted that its use has been limited to the pediatric population and at a very low dosage. [43, 44, 45]

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