Status asthmatics is very difficult to treat and can be very challenging to treat. Whats the MOA of ketamine in this condition.
Ketamine, a phencyclidine derivative, has been found to relax smooth muscle in airway by acting on various receptors and inflammatory cascades, which mediate bronchospasm. Pathways of action include NMDA recptor blocker, blocking Ca entry into smooth muscle and increase of catecholamines. Limited evidence to support use in status asthmaticus. Several studies in a pediatric population and at a very low dosage and several case reports have reported successfully ketamine use to manage status asthmaticus, resistant to conventional therapy,. Central nervous system sedation, which may require intubation, is a limitation of ketamine use. .
There is a literature base dating to about 1986 regarding use of ketamine for status asthmaticus [SA], as I'm sure you know. It has been shown to be effective at reducing obstruction from bronchospasm, reducing airway resistance when ventilator must be used, and reducing the use of ventilators. Used in ER, it is claimed to reduce the rate of hospitalization for SA (they do not comment on hospitalization for psychosis). There would be risks, including causing psychosis, dangerous agitation, dangerous increases in blood pressure (doubtless increased epinephrine release contributes secondarily to reduced bronchospasm). Here is a recent review article.
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