title: Efficacy and safety of ketamine in refractory status epilepticus in children.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of ketamine (KE) in the management of refractory convulsive status epilepticus (RSE) in children.
  
  
  METHODS
  In November 2009, we started using KE for treating all children consecutively referred for RSE. Clinical and treatment data were analyzed.
  
  
  RESULTS
  Between November 2009 and June 2011, 9 children with RSE received IV KE. In 8 patients, SE had persisted for more than 24 hours (super-refractory RSE), with a median of 6 days (mean 8.5 ± 7.5; range 2-26 days). Prior to KE administration, conventional anesthetics were used, including midazolam, thiopental, and propofol in 9, 5, and 4 patients each. Median dose of KE in continuous IV infusion was 40 gamma(μg)/kg/min (mean 36.5 ± 18.6 gamma[μg]/kg/min; range 10-60 gamma[μg]/kg/min). Midazolam was administered add-on to prevent emergence reactions. The use of KE was associated with resolution of RSE in 6 children. None of the patients experienced serious adverse events. Among the 3 individuals who did not respond to KE, 2 were cured by surgical removal of epileptogenic focal cortical dysplasia.
  
  
  CONCLUSIONS
  In this small, open-label, unblinded series with no concurrent control group, KE appears effective and safe in treating RSE in children. Larger, randomized studies are needed to confirm data emerging from this preliminary observation.
  
  
  METHODS
  This study provides Class IV evidence that IV KE can be effective in treating children with RSE (no statistical analysis was done).
authors.affiliation: Pediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Florence, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosati
authors.forename: Manuela
authors.initials: M
authors.lastname: L'Erario
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Ilvento
authors.forename: Costanza
authors.initials: C
authors.lastname: Cecchi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Pisano
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mirabile
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini
mesh_terms: D000777:Anesthetics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007649:Ketamine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D013226:Status Epilepticus / Q000188:drug therapy*; D013874:Thiopental / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000927:Anticonvulsants; D007649:Ketamine; D013874:Thiopental; D008874:Midazolam; D015742:Propofol