Ketamine infusion for refractory status epilepticus: A case report of cardiac arrest.

Abstract

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.

• Authors: Lauren Koffman, Ho Yan Yiu, Salia Farrokh, John Lewin 3rd, Romergryko Geocadin, Wendy Ziai
• Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia (J Clin Neurosci) Vol. 47 Pg. 149-151 (Jan 2018) ISSN: 1532-2653 [Electronic] Scotland
• PMID: 29107412 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2017 Elsevier Ltd. All rights reserved.

Chemical References

• Anticonvulsants
• Ketamine

Topics

• Aged
• Anticonvulsants (administration & dosage, adverse effects, therapeutic use)
• Female
• Heart Arrest (diagnosis, etiology)
• Humans
• Ketamine (administration & dosage, adverse effects, therapeutic use)
• Status Epilepticus (diagnosis, drug therapy)