From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine.
Neurology. 2022 Sep 20;99(12):e1227-e1238. doi: 10.1212/WNL.0000000000200889. Epub 2022 Jul 11.
Few data are available regarding the use of anesthetic infusions for refractory status epilepticus (RSE) in children and neonates, and ketamine use is increasing despite limited data. We aimed to describe the impact of ketamine for RSE in children and neonates.
Retrospective single-center cohort study of consecutive patients admitted to the intensive care units of a quaternary care children's hospital treated with ketamine infusion for RSE.
Sixty-nine patients were treated with a ketamine infusion for RSE. The median age at onset of RSE was 0.7 years (interquartile range 0.15-7.2), and the cohort included 13 (19%) neonates. Three patients (4%) had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in 2 patients and delirium in 1 patient. Ketamine infusion was followed by seizure termination in 32 patients (46%), seizure reduction in 19 patients (28%), and no change in 18 patients (26%).
Ketamine administration was associated with few adverse events, and seizures often terminated or improved after ketamine administration. Further data are needed comparing first-line and subsequent anesthetic medications for treatment of pediatric and neonatal RSE.
This study provides Class IV evidence on the therapeutic utility of ketamine for treatment of RSE in children and neonates.
有关麻醉输注在儿童和新生儿难治性癫痫持续状态（RSE）中的应用的数据很少，尽管数据有限，但氯胺酮的使用正在增加。我们旨在描述氯胺酮在儿童和新生儿 RSE 中的应用效果。
这是一项回顾性单中心队列研究，纳入了在一家四级儿童医院重症监护病房接受氯胺酮输注治疗 RSE 的连续患者。
69 名患者因 RSE 接受了氯胺酮输注治疗。RSE 发作的中位年龄为 0.7 岁（四分位距 0.15-7.2），该队列包括 13 名（19%）新生儿。3 名患者（4%）在氯胺酮给药期间或 12 小时内发生需要干预的不良事件，包括 2 名患者出现高血压和 1 名患者出现谵妄。氯胺酮输注后，32 名患者（46%）癫痫发作终止，19 名患者（28%）癫痫发作减少，18 名患者（26%）无变化。
氯胺酮给药后不良事件很少，且常在给药后癫痫发作终止或改善。需要进一步的数据比较一线和后续麻醉药物治疗儿科和新生儿 RSE。
本研究提供了 IV 级证据，表明氯胺酮在治疗儿童和新生儿 RSE 方面具有治疗作用。
