• T T Lau and P J Zed.
• CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, BC, Canada.
• Pharmacotherapy. 2001 Sep 1; 21 (9): 1100-6.

ObjectiveTo evaluate the role of ketamine in management of severe exacerbation of asthma in adults.MethodsQualitative systematic search using MEDLINE (January 1966-September 2000), EMBASE (January 1988-September 2000), and the Cochrane Database of Systematic Reviews (Issue 2, 2000).ResultsOne 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.ConclusionLimited 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.

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