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Use of Continuous Ketamine Infusion as an Adjunctive Agent in Young Infants With Refractory and Super Refractory

Mackenzie N DeVine1, Sharon E Gordon1, Craig A Press2,3

  • 1Department of Pharmacy (MND, SEG), Children's Hospital Colorado, Aurora, CO.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|May 4, 2023
PubMed

Insights

Continuous ketamine infusions show promise for treating refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) in infants. This case series suggests ketamine is a safe and effective adjunctive therapy for RSE and SRSE in neonates.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) pose significant challenges in pediatric care.
  • Limited data exists on the use of continuous ketamine infusions in young infants for RSE/SRSE.

Purpose of the Study:

  • To evaluate the efficacy, safety, and dosing of continuous ketamine infusions in young infants with RSE and SRSE.
  • To present the first case series on continuous ketamine use in this specific pediatric population.

Main Methods:

  • Retrospective case series of 3 young infants with RSE/SRSE treated with continuous ketamine infusions.
  • Ketamine initiated at 1 mg/kg/hr, with titration up to 6 mg/kg/hr in one patient.
  • Concomitant use of other antiseizure medications was noted.

Main Results:

  • All patients had RSE/SRSE refractory to an average of 6 antiseizure medications prior to ketamine.
  • Continuous ketamine infusions were initiated and generally well-tolerated, even with hemodynamic instability.
  • One patient experienced a reduction in benzodiazepine infusion rate with ketamine use.

Conclusions:

  • Continuous ketamine may serve as a safe and effective adjunctive treatment for severe RSE and SRSE in young infants.
  • This study is the first to document the use of continuous ketamine in infants with RSE/SRSE without adverse events.
  • Further research is required to ascertain long-term safety and efficacy in this population.

Keywords:
infantketaminerefractory status epilepticussuper refractory status epilepticus

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