Madam Editor:
In relation to the work of Rivero Rodríguez D, et al., we would like to expand on some aspects of the role of ketamine in the treatment of refractory status epilepticus. The third-line drugs most commonly used in refractory status epilepticus are midazolam, propofol, and thiopental. As a general rule, thiopental is considered slightly more effective in the short term, while midazolam and propofol are used as alternatives with a more favorable adverse effect profile, without a significant difference in long-term outcomes.
Ketamine, an anesthetic that acts by blocking N-methyl-D-aspartate (NMDA) glutamate receptors, is characterized by its short half-life and its ability not to compromise respiration, preserving airway protective reflexes. Among other theoretical benefits are the reduction of NMDA receptor-mediated excitotoxicity, which decreases neuronal metabolic demands, as well as a direct neuroprotective effect by blocking NMDA receptor-mediated apoptosis induction.
