Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation

Lucrezia Ilvento, Anna Rosati, Carla Marini, Manuela L'Erario, Lorenzo Mirabile, Renzo Guerrini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The purpose of this study was to report on the efficacy and safety of intravenous ketamine (KE) in refractory convulsive status epilepticus (RCSE) in children and highlight its advantages with particular reference to avoiding endotracheal intubation. Methods: Since November 2009, we have used a protocol to treat RCSE including intravenous KE in all patients referred to the Neurology Unit of the Meyer Children's Hospital. Results: From November 2009 to February 2015, 13 children (7 females; age: 2 months-11 years and 5 months) received KE. Eight patients were treated once, two were treated twice, and the remaining three were treated 3 times during different RCSE episodes, for a total of 19 treatments. Most of the RCSE episodes were generalized (14/19). A malformation of cortical development was the most frequent etiology (4/13 children). Ketamine was administered from a minimum of 22 h to a maximum of 17 days, at doses ranging from 7 to 60 mcg/kg/min, obtaining a resolution of the RCSE in 14/19 episodes. Five patients received KE in lieu of conventional anesthetics, thus, avoiding endotracheal intubation. Ketamine was effective in 4 of them. Suppression-burst pattern was observed after the initial bolus of 3 mg/kg in the majority of the responder RCSE episodes (10/14). Conclusions: Ketamine is effective in treating RCSE and represents a practical alternative to conventional anesthetics for the treatment of RCSE. Its use avoids the pitfalls and dangers of endotracheal intubation, which is known to worsen RCSE prognosis.

Original languageEnglish
Pages (from-to)343-346
Number of pages4
JournalEpilepsy and Behavior
Volume49
DOIs
Publication statusPublished - Aug 1 2015

Keywords

  • Children
  • Conventional anesthetics
  • Endotracheal intubation
  • Ketamine
  • Refractory status epilepticus
  • Status epilepticus

ASJC Scopus subject areas

  • Clinical Neurology
  • Behavioral Neuroscience
  • Neurology

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