TY - JOUR
T1 - Ketamine infusion for refractory status epilepticus
T2 - A case report of cardiac arrest
AU - Koffman, Lauren
AU - Yan Yiu, Ho
AU - Farrokh, Salia
AU - Lewin, John
AU - Geocadin, Romergryko
AU - Ziai, Wendy
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2018/1
Y1 - 2018/1
N2 - Background Refractory status epilepticus (RSE) has a high mortality rate and is often difficult to treat. When traditional therapies fail ketamine may be considered. There are limited reports of adverse cardiac events with the use of ketamine for RSE and no reports of cardiac arrest in this context. Objective Evaluate the occurrence of cardiac arrhythmias associated with the use of ketamine for RSE. Methods Retrospective chart review of nine patients who underwent ketamine infusion for RSE. Results Etiology of refractory status epilepticus included autoimmune/infectious process (Zeiler et al., 2014), ischemic stroke (Bleck, 2005) and subarachnoid hemorrhage (Bleck, 2005). Of the nine patients who received ketamine, two had documented cardiac events; one remained clinically stable and the other developed multiple arrhythmias, including recurrent episodes of asystole. Once ketamine was discontinued the latter patient stabilized with the addition of anti arrhythmic therapy. Conclusion Ketamine is utilized to treat refractory status epilepticus, but should be used with caution in patients with subarachnoid hemorrhage, as there may be an increased risk of life threatening arrhythmias and cardiac arrest.
AB - Background Refractory status epilepticus (RSE) has a high mortality rate and is often difficult to treat. When traditional therapies fail ketamine may be considered. There are limited reports of adverse cardiac events with the use of ketamine for RSE and no reports of cardiac arrest in this context. Objective Evaluate the occurrence of cardiac arrhythmias associated with the use of ketamine for RSE. Methods Retrospective chart review of nine patients who underwent ketamine infusion for RSE. Results Etiology of refractory status epilepticus included autoimmune/infectious process (Zeiler et al., 2014), ischemic stroke (Bleck, 2005) and subarachnoid hemorrhage (Bleck, 2005). Of the nine patients who received ketamine, two had documented cardiac events; one remained clinically stable and the other developed multiple arrhythmias, including recurrent episodes of asystole. Once ketamine was discontinued the latter patient stabilized with the addition of anti arrhythmic therapy. Conclusion Ketamine is utilized to treat refractory status epilepticus, but should be used with caution in patients with subarachnoid hemorrhage, as there may be an increased risk of life threatening arrhythmias and cardiac arrest.
KW - Ketamine
KW - Refractory status epilepticus
KW - Status epilepticus
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U2 - 10.1016/j.jocn.2017.10.044
DO - 10.1016/j.jocn.2017.10.044
M3 - Article
C2 - 29107412
AN - SCOPUS:85032301162
SN - 0967-5868
VL - 47
SP - 149
EP - 151
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -