Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation

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

doi:10.1016/j.yebeh.2015.06.019

Cited by 61 publications

(67 citation statements)

References 20 publications

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“…reduced microglia activation, reduction of inflammatory cytokines, such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) and the reduction of spreading depolarizations [49]. Patients with brain injuries also benefit from the antioxidative [50] and anticonvulsive [50–53] effects of S(+)-ketamine. Due to its stabilizing effects on the circulation, it also helps to limit hypotension and therefore, potentially, hypotension-related secondary brain damage [50].…”

Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

S(+)-ketamine

Trimmel

Helbok

Staudinger

et al. 2018

Wien Klin Wochenschr

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SummaryS(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

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Section: S(+)-ketamine In Intensive Care Medicinementioning

confidence: 99%

S(+)-ketamine

Trimmel

Helbok

Staudinger

et al. 2018

Wien Klin Wochenschr

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“…There are 26 studies on the use of KET in SE, including 18 single case reports (14 on adults and four on children) and eight case series (five on adults and three on children) available.…”

Section: Resultsmentioning

confidence: 99%

“…One pediatric case series included only one patient with KET; this study was therefore counted as a case report . Six case series were conducted in a single center, and one was a multicenter study . Except for two prospective pediatric studies, all others were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Intravenous ketamine in status epilepticus

Höfler

Trinka

2018

Epilepsia

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Status epilepticus (SE) is among the most common neurological emergencies. In refractory SE, due to subcellular maladaptive changes, γ-aminobutyric acidergic drugs are no longer effective, and there is an increase in synaptic N-methyl-d-aspartate (NMDA) receptors. Ketamine (KET) is a noncompetitive N-methyl-d-aspartate receptor antagonist that could be of value in the treatment of refractory SE. The aim was to analyze all published studies on KET in the treatment of SE. A systematic search (PubMed) of the literature identified 25 studies (from December 1996 to March 2017); with the exception of two prospective studies, all studies were retrospective in nature and published as a full paper. To date, PubMed lists a total number of 244 episodes of SE treated with KET (13 case reports and five case series in adults; four case reports and three case series in children); the overall success rate was 74% (153/207) in adults and 73% (27/37) in children. Adverse events were rare. Current evidence on the use of KET in acute seizures and SE is mostly restricted to retrospective case reports and case series, except for two prospective case series without control (class IV). Further prospective studies to inform clinicians are necessary.

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“…Ketamine has received attention in the management of refractory SE . While the agent is well known to emergency physicians and increasingly to pre‐hospital providers, there is no evidence to suggest the utility in paediatric SE management in this setting at the moment.…”

Section: Resultsmentioning

confidence: 99%

“…Ketamine has received attention in the management of refractory SE. 48,49 While the agent is well known to emergency physicians and increasingly to pre-hospital providers, there is no evidence to suggest the utility in paediatric SE management in this setting at the moment. Large multicentre studies are being conducted in the USA, UK, Australia and NZ, examining the effectiveness of second-line agents levetiracetam and valproate compared to phenytoin.…”

Section: Future Trends and Emerging Conceptsmentioning

confidence: 99%

Review article: Paediatric status epilepticus in the pre‐hospital setting: An update

Furyk

Watt

Emeto

et al. 2017

Emerg Medicine Australasia

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Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.

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Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation

Cited by 61 publications

References 20 publications

S(+)-ketamine

S(+)-ketamine

Intravenous ketamine in status epilepticus

Review article: Paediatric status epilepticus in the pre‐hospital setting: An update

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