Abstract Details

Title Use of Ketamine for Refractory Status Epilepticus to Avoid Endotracheal Intubation in Adult Patients

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 031

Objective To determine the safety and efficacy of ketamine in the treatment of refractory status epilepticus (RSE) in non-intubated patients.

Background Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist used in RSE with favorable safety profile, including hemodynamic stability, maintained airway protective mechanisms and lack of respiratory depression. Mechanical ventilation may be associated with systemic complications. We evaluated the efficacy of ketamine in the treatment of RSE in non-intubated patients.

Design/Methods We retrospectively reviewed the local Neurocritical care database for non-intubated RSE patients where ketamine was the first anesthetic agent. Cessation of RSE based on continuous EEG was evaluated after ketamine.

Results Over six months, six patients, median age 63 years (range 58-70), two females/four males, were identified. Five patients had a structural etiology and one patient had non-structural etiology. RSE was non-convulsive in three patients. Three patients had successful cessation of RSE on ketamine alone. All three patients did not require intubation. The median dose of benzodiazepine (lorazepam equivalent) prior to ketamine in successful patients was 0.11(range 0.1-0.18) mg/kg, and 0.15(range 0.12-0.4) mg/kg in unsuccessful. The average maximum dose of ketamine in successful patients was 1.6(±1.66) mg/kg/hr compared to 1.8(±1.89) mg/kg/hr in unsuccessful patients. The average number of anti-epileptics prior to ketamine in successful patients was 2.75 and 3.5 in unsuccessful. Four patients had no ketamine side-effects, one patient had hypotension and one patient had excessive secretions. Mean length of stay in successful patients was 15.6(±6.4) days versus 30(±18.4) days in unsuccessful patients. Outcomes included two deaths, three to skilled nursing facility and one discharged home.

Conclusions Ketamine has been established as a potential treatment of RSE. Ketamine usage may be considered in non-intubated, non-comatose patients to treat RSE. However, close hemodynamic and airway monitoring in a critical care setting is required for these patients.

Authors/Disclosures
Maryam J. Syed, MBBS (Wayne State University School of Medicine) PRESENTER	Dr. Syed has nothing to disclose.
Maryam J. Syed, MBBS (Wayne State University School of Medicine)	Dr. Syed has nothing to disclose.
Shishir K. Rao, MD (Wellstar Health Sciences)	The institution of Dr. Rao has received research support from Eisai, Inc.
Ayaz M. Khawaja, MD	Dr. Khawaja has nothing to disclose.
Wazim Mohamed, MD (Detroit Medical Center/Wayne State University)	Dr. Mohamed has nothing to disclose.

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