title: Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation.
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".
authors.affiliation: Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy. Electronic address: r.guerrini@meyer.it.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Ilvento
authors.affiliation: Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosati
authors.affiliation: Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Marini
authors.affiliation: Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: L'Erario
authors.affiliation: Intensive Care Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mirabile
authors.affiliation: Pediatric Neurology Unit, Children's Hospital "A. Meyer", University of Florence, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Guerrini
mesh_terms: D061605:Administration, Intravenous; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000002:abnormalities / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D004829:Epilepsy, Generalized; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D012008:Recurrence; D012472:Salivation / Q000187:drug effects; D013226:Status Epilepticus / Q000188:drug therapy*
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine
keywords: Children; Conventional anesthetics; Endotracheal intubation; Ketamine; Refractory status epilepticus; Status epilepticus