Intravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study

被引：188

作者：

Gaspard, Nicolas ^{[1
]}

Foreman, Brandon ^{[2
,3
]}

Judd, Lilith M. ^{[4
]}

Brenton, James N. ^{[5
]}

Nathan, Barnett R. ^{[5
]}

McCoy, Blathnaid M. ^{[6
]}

Al-Otaibi, Ali ^{[6
]}

Kilbride, Ronan ^{[7
,8
]}

Fernandez, Ivan Sanchez ^{[9
]}

Mendoza, Lucy ^{[10
]}

Samuel, Sophie ^{[11
]}

Zakaria, Asma ^{[11
]}

Kalamangalam, Giridhar P. ^{[11
]}

Legros, Benjamin ^{[12
]}

Szaflarski, Jerzy P. ^{[10
]}

Loddenkemper, Tobias ^{[9
]}

Hahn, Cecil D. ^{[6
]}

Goodkin, Howard P. ^{[5
]}

Claassen, Jan ^{[2
,3
]}

Hirsch, Lawrence J. ^{[1
]}

LaRoche, Suzette M. ^{[4
]}

机构：

[1] Yale Univ, Yale New Haven Hosp, Sch Med, Comprehens Epilepsy Ctr,Dept Neurol, New Haven, CT 06520 USA

[2] Columbia Univ Coll Phys & Surg, Div Crit Care Neurol, New York, NY 10032 USA

[3] Med Ctr, New York, NY USA

[4] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA 30322 USA

[5] Univ Virginia, Dept Neurol, Charlottesville, VA USA

[6] Hosp Sick Children, Div Neurol, Toronto, ON M5G 1X8, Canada

[7] Massachusetts Gen Hosp, Dept Neurol, Epilepsy Serv, Boston, MA 02114 USA

[8] Massachusetts Gen Hosp, Dept Neurol, Clin Neurophysiol Serv, Boston, MA 02114 USA

[9] Boston Childrens Hosp, Div Epilepsy & Clin Neurophysiol, Boston, MA USA

[10] Univ Cincinnati, Acad Hlth Ctr, Dept Neurol, Cincinnati, OH USA

[11] Univ Texas Hlth Sci Ctr Houston, Dept Neurol, Houston, TX 77030 USA

[12] ULB Hop Erasme, Dept Neurol, Reference Ctr Treatment Refractory Epilepsy, Brussels, Belgium

来源：

EPILEPSIA | 2013年 / 54卷 / 08期

基金：

加拿大健康研究院; 美国国家卫生研究院;

关键词：

Ketamine; Treatment; Refractory status epilepticus; Anesthetics; Antiepileptic drugs; MIDAZOLAM; ACIDOSIS; IMPACT;

D O I：

10.1111/epi.12247

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Purpose To examine patterns of use, efficacy, and safety of intravenous ketamine for the treatment of refractory status epilepticus (RSE). Methods Multicenter retrospective review of medical records and electroencephalography (EEG) reports in 10 academic medical centers in North America and Europe, including 58 subjects, representing 60 episodes of RSE that were identified between 1999 and 2012. Seven episodes occurred after anoxic brain injury. Key Findings Permanent control of RSE was achieved in 57% (34 of 60) of episodes. Ketamine was felt to have contributed to permanent control (possible or likely responses) in 32% (19 of 60) including seven (12%) in which ketamine was the last drug added (likely responses). Four of the seven likely responses, but none of the 12 possible ones, occurred in patients with postanoxic brain injury. No likely responses were observed when infusion rates were lower than 0.9mg/kg/h, when ketamine was introduced at least 8days after SE onset, or after failure of seven or more drugs. Ketamine was discontinued due to possible adverse events in five patients. Complications were mostly attributed to concurrent drugs, especially other anesthetics. Mortality rate was 43% (26 of 60), but was lower when SE was controlled within 24h of ketamine initiation (16% vs. 56%, p=0.0047). Significance Ketamine appears to be a relatively effective and safe drug for the treatment of RSE. This retrospective series provides preliminary data on effective dose and appropriate time of intervention to aid in the design of a prospective trial to further define the role of ketamine in the treatment of RSE.

引用

页码：1498 / 1503

页数：6

共 27 条

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