Does ketamine have a role in managing severe exacerbation of asthma in adults?
OBJECTIVE
To evaluate the role of ketamine in management of severe exacerbation of asthma in adults.


METHODS
Qualitative systematic search using MEDLINE (January 1966-September 2000), EMBASE (January 1988-September 2000), and the Cochrane Database of Systematic Reviews (Issue 2, 2000).


RESULTS
One prospective, randomized, double-blind, placebo-controlled trial and five case reports were retrieved. In the clinical trial, low-dosage ketamine as an adjunct to standard therapy offered no benefit in improving outcomes in nonventilated patients. In the case reports, all patients with refractory severe exacerbation of asthma requiring mechanical ventilation appeared to receive some benefit from ketamine, with alleviation of bronchospasm and improved oxygenation. Adverse effects included dysphoria, hallucinations, and increased pulmonary secretions.


CONCLUSIONS
Limited evidence is available in the literature to support administration of ketamine in severe exacerbation of asthma. Although a few cases suggest possible benefit from ketamine, it should not be considered until controlled clinical trials demonstrate that benefits outweigh risks for patients for whom other standard therapies failed.
Lau
T T
TT
CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Zed
P J
PJ
D000328:Adult; D001249:Asthma / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine