Ketamine – Cure For Everything

There aren’t many medications I love using more than ketamine.  I use it for adjunctive pain control, to control agitation, and for induction prior to intubation.  Now, chances are, it’s probably useful in seizures.

This is a case report and review of the literature for the use of ketamine in the control of refractory status epilepticus.  The literature is profoundly weak – the “review” is essentially a review of case reports.  And, the patient outcomes describe in the case reports are replete with “All died” or “Survived but severely disabled.”  However, this is primarily due to the serious cause of the underlying disorders – encephalitis, neurosyphilis, meningitis, anoxic brain injury – and less likely the ketamine, although this does not provide the evidence to that effect.  The proposed mechanism is via NMDA receptor antagonism, which the author proposes works better by synergy with GABA antagonism, rather than either as monotherapy.

Seems like a fair physiologic mechanism, and it’s nice to have something additional to consider in refractory disease.  Ketamine also was noted in this case report to counteract the hypotensive effects of midazolam and propofol, consistent with prior literature describing its beneficial effect on cerebral perfusion pressure.  It’s pretty much a “I tried this and I like it” article, but I think it’s probably likable and not the last we’ve heard about ketamine for status.

“Early Ketamine to Treat Refractory Status Epilepticus”