Lucrezia Ilvento1, Anna Rosati2, Carla Marini2, Manuela L'Erario3, Lorenzo Mirabile3, Renzo Guerrini2. 1. Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy. Electronic address: r.guerrini@meyer.it. 2. Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy. 3. Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
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 3mg/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. This article is part of a Special Issue entitled "Status Epilepticus".
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 3mg/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. This article is part of a Special Issue entitled "Status Epilepticus".
Authors: David G Vossler; Jacquelyn L Bainbridge; Jane G Boggs; Edward J Novotny; Tobias Loddenkemper; Edward Faught; Marta Amengual-Gual; Sarah N Fischer; David S Gloss; Donald M Olson; Alan R Towne; Dean Naritoku; Timothy E Welty Journal: Epilepsy Curr Date: 2020-08-21 Impact factor: 7.500
Authors: Helmut Trimmel; Raimund Helbok; Thomas Staudinger; Wolfgang Jaksch; Brigitte Messerer; Herbert Schöchl; Rudolf Likar Journal: Wien Klin Wochenschr Date: 2018-01-10 Impact factor: 1.704