pem pearl: ketamine for status epilepticus
Here is another RCT evaluating the use of ketamine for status epilepticus. In this study, patients were divided into two groups- the first group received combined ketamine (2mg/kg) and midazolam (0.2mg/kg) and the second received midazolam (0.2mg/kg) and placebo for first-line abortive therapy in seizures. Children in the combined group achieved 76% seizure termination at 5-minutes compared to 21% in the placebo group. Adverse events were altogether rare; those in the placebo group experienced more hypotension.
Some problems with generalizability of this study: it came from a tertiary care center in Egypt where, once the children had reached the center, they had been seizing for an average of 34 minutes already. No IV meds had been given prior to arrival at the hospital. Additionally, CNS infections were quite common, accounting for 11% of the cases.
Bottom line: Ketamine has been on the rise as a potential abortive medication in status epilepticus. This study adds to this literature, but has its limitations in terms of broad application. Consider reaching for ketamine early with refractory seizures, and especially in patients in status with more tenuous hemodynamics.
Some problems with generalizability of this study: it came from a tertiary care center in Egypt where, once the children had reached the center, they had been seizing for an average of 34 minutes already. No IV meds had been given prior to arrival at the hospital. Additionally, CNS infections were quite common, accounting for 11% of the cases.
Bottom line: Ketamine has been on the rise as a potential abortive medication in status epilepticus. This study adds to this literature, but has its limitations in terms of broad application. Consider reaching for ketamine early with refractory seizures, and especially in patients in status with more tenuous hemodynamics.
