Use of ketamine for severe asthma exacerbation in a pregnant patient with persistent bronchospasm: a case report

Estimated 4%–8% of pregnancies are complicated by asthma. Adequate management in this population is critical to minimize complications. Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids. However, additional agents may be used in patients with refractory asthma exacerbation. Ketamine has been used in refractory bronchospasm, although its efficacy in published literature is heterogeneous. We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion. After receiving ketamine infusion for several days, the patient had improved air flow and achieved successful extubation, without experiencing rebound bronchospasm. Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations, it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.