Is ketamine a lifesaving agent in childhood acute severe asthma?

Mohamed A Hendaus, Fatima A Jomha, Ahmed H Alhammadi, Mohamed A Hendaus, Fatima A Jomha, Ahmed H Alhammadi

Abstract

Children with acute severe asthma exacerbation are at risk of developing respiratory failure. Moreover, conventional aggressive management might be futile in acute severe asthma requiring intubation and invasive ventilation. The aim of this review is to detail evidence on the use of ketamine in childhood asthma exacerbations. A search of the MEDLINE, EMBASE, and Cochrane databases was performed, using different combinations of the following terms: ketamine, asthma, use, exacerbation, and childhood. In addition, we searched the references of the identified articles for additional articles. We then reviewed titles and included studies that were relevant to the topic of interest. Finally, the search was limited to studies published in English and Spanish from 1918 to June 2015. Due to the scarcity in the literature, we included all published articles. The literature reports conflicting results of ketamine use for acute severe asthma in children. Taking into consideration the relatively good safety profile of the drug, ketamine might be a reasonable option in the management of acute severe asthma in children who fail to respond to standard therapy. Furthermore, pediatricians and pediatric emergency clinicians administering ketamine should be knowledgeable about the unique actions of this drug and its potential side effects.

Keywords: asthma; children; ketamine.

References

    1. GINA [webpage on the Internet] Global Strategy for Asthma Management and Prevention. [Accessed February 26, 2015]. Available from: .
    1. Rust G, Zhang S, Reynolds J. Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma. J Asthma. 2013;50:769–775.
    1. Kaza V, Bandi V, Guntupalli KK. Acute severe asthma: recent advances. Curr Opin Pulm Med. 2007;13(1):1–7.
    1. Kelly CS, Andersen CL, Pestian J, et al. Improved outcomes for hospitalized asthmatic children using a clinical pathway. Ann Allergy Asthma Immunol. 2000;84:509–516.
    1. Birken CS, Parkin PC, Macarthur C. Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. J Clin Epidemiol. 2004;57:1177–1181.
    1. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma – United States, 1980–1999. MMWR Surveill Summ. 2002;51:1–13.
    1. Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality: United States, 2005–2009. Natl Health Stat Report. 2011;32:1–14.
    1. Akinbami LJ, Schoendorf KC, Parker J. US childhood asthma prevalence estimates: the impact of the 1997 National Health Interview Survey redesign. Am J Epidemiol. 2003;158:99–104.
    1. Akinbami L. The state of childhood asthma, United States, 1980–2005. Adv Data. 2006;381:1–24.
    1. Werner HA. Status asthmaticus in children: a review. Chest. 2001;119:1913–1929.
    1. Sly RM. Decreases in Hispanic and non-Hispanic asthma mortality. Ann Allergy Asthma Immunol. 2006;96:76–79.
    1. Maddox RP, Seupaul RA. Is ketamine effective for the management of acute asthma exacerbations in children? Ann Emerg Med. 2014;63:309–310.
    1. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57:449–461.
    1. Denmark TK, Crane HA, Brown L. Ketamine to avoid mechanical ventilation in severe pediatric asthma. J Emerg Med. 2006;30:163–166.
    1. Petrillo TM, Fortenberry JD, Linger JF, Simon HK. Emergency department use of ketamine in pediatric status asthmaticus. J Asthma. 2001;38:657–664.
    1. Shlamovitz GZ, Hawthorne T. Intravenous ketamine in a dissociating dose as a temporizing measure to avoid mechanical ventilation in adult patient with severe asthma exacerbation. J Emerg Med. 2011;41:492–494.
    1. L’Hommedieu CS, Arens JJ. The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med. 1987;16:568–571.
    1. Rock MJ, Reyes de la Rocha S, L’Hommedieu CS, Truemper E. Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy. Crit Care Med. 1986;14:514–516.
    1. Ketamine [webpage on the Internet] Center for Substance Abuse Research (CESAR) University of Maryland; [Accessed December 25, 2014]. Available from: .
    1. WHO . WHO Model List of Essential Medicines. 18th ed. Geneva: World Health Organization; 2013.
    1. Li Y, Coller JK, Hutchinson MR, et al. The CYP2B6*6 allele significantly alters the N-demethylation of ketamine enantiomers in vitro. Drug Metab Dispos. 2013;41:1264–1272.
    1. Stevenson C. Ketamine: a review. Update Anaesth. 2005;20:25–29.
    1. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36:186–197.
    1. Brunette KE, Anderson BJ, Thomas J, Wiesner L, Herd DW, Schulein S. Exploring the pharmacokinetics of oral ketamine in children undergoing burns procedures. Paediatr Anaesth. 2011;21:653–662.
    1. Quibell R, Prommer EE, Mihalyo M, Twycross R, Wilcock A. Ketamine. J Pain Symptom Manage. 2011;41:640–649.
    1. Sinner B, Graf BM. Ketamine. In: Schüttler J, Schwilden H, editors. Modern Anesthetics Handbook of Experimental Pharmacology. Vol. 182. Berlin: Springer; 2008. pp. 313–333.
    1. Kohrs R, Durieux ME. Ketamine: teaching an old drug new tricks. Anesth Analg. 1998;87:1186–1193.
    1. Bergman SA. Ketamine: review of its pharmacology and its use in pediatric anesthesia. Anesth Prog. 1999;46:10–20.
    1. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol. 2009;49:957–964.
    1. Li JH, Vicknasingam B, Cheung YW, et al. To use or not to use: an update on licit and illicit ketamine use. Subst Abuse Rehabil. 2011;16:11–20.
    1. Medscape; Ketamine [webpage on the Internet]; [Accessed December 7, 2015]. Available from: .
    1. Basow DS, editor. Ketamine [webpage on the Internet] Waltham, MA: [Accessed December 8, 2015]. UpToDate. Available from: .
    1. Goyal S, Agrawal A. Ketamine in status asthmaticus: a review. Indian J Crit Care Med. 2013;17:154–161.
    1. Chang Y, Chen TL, Sheu JR, Chen RM. Suppressive effects of ketamine on macrophage functions. Toxicol Appl Pharmacol. 2005;204:27–35.
    1. White PF, Way WL, Trevor AJ. Ketamine – its pharmacology and therapeutic uses. Anesthesiology. 1982;56:119–136.
    1. Allen JY, Macias CG. The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma. Ann Emerg Med. 2005;46:43–50.
    1. Zhu MM, Qian YN, Zhu W, et al. Protective effects of ketamine on allergen-induced airway inflammatory injure and high airway reactivity in asthma: experiment with rats. Zhonghua Yi Xue Za Zhi. 2007;87:1308–1313.
    1. Zhu MM, Zhou QH, Zhu MH, et al. Effects of nebulized ketamine on allergen-induced airway hyperresponsiveness and inflammation in actively sensitized Brown-Norway rats. J Inflamm (Lond) 2007;4:10.
    1. Sato T, Hirota K, Matsuki A, Zsigmond EK, Rabito SF. The role of the N-Methyl-D-Aspartic acid receptor in the relaxant effect of ketamine on tracheal smooth muscle. Anesth Analg. 1998;87:1383–1388.
    1. Hirota K, Sato T, Rabito SF, Zsigmond EK, Matsuki A. Relaxant effect of ketamine and its isomers on histamine-induced contraction of tracheal smooth muscle. Br J Anaesth. 1996;76:266–270.
    1. Heshmati F, Zeinali MB, Noroozinia H, Abbacivash R, Mahoori A. Use of ketamine in severe status asthmaticus in intensive care unit. Iran J Allergy Asthma Immunol. 2003;2:175–180.
    1. Bourke DL, MAlit LA, Smith TC. Respiratory interactions of ketamine and morphine. Anesthesiology. 1987;66:153–156.
    1. Hamza J, Ecoffey C, Gross JB. Ventilatory response to CO2 following intravenous ketamine in children. Anesthesiology. 1989;70:422–425.
    1. Shulman D, Beardsmore CS, Aronson HB, Godfrey S. The effect of ketamine on the functional residual capacity in young children. Anesthesiology. 1985;62:551–556.
    1. Morris H, Wallach J. From PCP to MXE: a comprehensive review of the non-medical use of dissociative drugs. Drug Test Anal. 2014;6:614–632.
    1. Betts EK, Parkin CE. Use of ketamine in an asthmatic child: a case report. Anesth Analg. 1971;50(3):420–421.
    1. Corssen G, Gutierrez J, Reves JG, Huber FC., Jr Ketamine in the anesthetic management of asthmatic patients. Anesth Analg Curr Res. 1972;51:588–596.
    1. Strube PJ, Hallam PL. Ketamine by continuous infusion in status asthmaticus. Anaesthesia. 1986;41:1017–1019.
    1. Sarma VJ. Use of ketamine in acute severe asthma. Acta Anaesthesiol Scand. 1992;36:106–107.
    1. Jahangir SM, Islam F, Chowdhury SN, Aziz L, Ghani MA. Ketamine infusion for postoperative analgesia: a prospective cohort study in asthmatics. Bangladesh Med Res Counc Bull. 1993;19:21–27.
    1. Hemmingsen C, Nielsen PK, Odorico J. Ketamine in the treatment of bronchospasm during mechanical ventilation. Am J Emerg Med. 1994;12:417–420.
    1. Youssef-Ahmed MZ, Silver P, Nimkoff L, Sagy M. Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm. Intensive Care Med. 1996;22:972–976.
    1. Jat KR, Azad C, Guglani V. Use of ketamine for refractory wheezing in an infant. Indian Pediatr. 2012;49:587–588.
    1. Agrawal A, Shrivastava J. Intravenous ketamine for refractory bronchospasm precipitated by H1N1 infection. Front Pediatr. 2014;2:24.
    1. Howton JC, Rose J, Duffy S, Zoltanski T, Levitt MA. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med. 1996;27:170–175.
    1. Jat KR, Chawla D. Ketamine for management of acute exacerbations of asthma in children. Cochrane Database Syst Rev. 2012;11:CD009293.
    1. Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006;367:766–780.
    1. Corssen G, Little SC, Tavakoli M. Ketamine and epilepsy. Anesthes Analg. 1974;53:319–335.
    1. Jolly T, McLean HS. Use of ketamine during procedural sedation. J Infus Nurs. 2012;35:377–382.
    1. Umunna BP, Tekwani K, Barounis D, Kettaneh N, Kulstad E. Ketamine for continuous sedation of mechanically ventilated patients. J Emerg Trauma Shock. 2015;8:11–15.
    1. Watts K, Chavasse RJ. Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children. Cochrane Database Syst Rev. 2012;5:CD006100.
    1. Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled emergency department trial. Ann Emerg Med. 2000;36(6):579–588.
    1. Slikker W, Jr, Zou X, Hotchkiss CE, et al. Ketamine-induced neuronal cell death in the perinatal rhesus monkey. Toxicol Sci. 2007;98(1):145–158.
    1. Jevtovic-Todorovic V, Hartman RE, Izumi Y, et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–882.
    1. Mazoit JX, Roulleau P, Baujard C. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain: isoflurane or ischemia-reperfusion? Anesthesiology. 2010;113(5):1245. author reply 1245–1246.
    1. Ikonomidou C, Bosch F, Miksa M, et al. Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science. 1999;283(5398):70–74.
    1. Zou X, Patterson TA, Sadovova N, et al. Potential neurotoxicity of ketamine in the developing rat brain. Toxicol Sci. 2009;108:149–158.
    1. Shi Q, Guo L, Patterson TA, et al. Gene expression profiling in the developing rat brain exposed to ketamine. Neuroscience. 2010;166:852–863.
    1. Braun S, Gaza N, Werdehausen R, et al. Ketamine induces apoptosis via the mitochondrial pathway in human lymphocytes and neuronal cells. Br J Anaesth. 2010;105(3):347–354.
    1. Morgan CJ, Riccelli M, Maitland CH, Curran HV. Long-term effects of ketamine: evidence for a persisting impairment of source memory in recreational users. Drug Alcohol Depend. 2004;75:301–308.
    1. Ubogu EE, Sagar SM, Lerner AJ, Maddux BN, Suarez JI, Werz MA. Ketamine for refractory status epilepticus: a case of possible ketamine-induced neurotoxicity. Epilepsy Behav. 2003;4:70–75.

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