Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus

Epilepsy Behav. 2015 Nov;52(Pt A):264-6. doi: 10.1016/j.yebeh.2015.07.040. Epub 2015 Nov 6.

Abstract

Retrospective analysis was conducted of patients with SRSE who were treated simultaneously with propofol and ketamine. Sixty-seven patients were identified from 2012 to 2015, and outcomes documented were resolution and mortality. The duration of combined ketamine and propofol use ranged from 1 to 28 days (mean - 3.6 days). Infusion rates ranged up to 145 and 175 mcg/kg/min. Vasopressors were used in 53 patients (79%), and were given within the first 5 days of the ICU admission in 48 (91%) patients. The overall SRSE resolution rate was 91%, and the overall mortality including patients with anoxic brain injury was 39%. Of the 13 patients with SRSE as a result of anoxic brain injury, SRSE was controlled in 5 (56%). The primary determinant of mortality was family withdrawing care related to the presence of severe medical/neurological diseases.

Keywords: Anesthetic agents; Ketamine; Mortality; Propofol; Seizure control; Super-refractory status epilepticus; Treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthetics, Dissociative / administration & dosage
  • Anesthetics, Dissociative / adverse effects
  • Anesthetics, Dissociative / therapeutic use*
  • Anesthetics, Intravenous / administration & dosage
  • Anesthetics, Intravenous / adverse effects
  • Anesthetics, Intravenous / therapeutic use*
  • Child
  • Critical Care
  • Drug Resistant Epilepsy / drug therapy*
  • Drug Resistant Epilepsy / mortality
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypoxia, Brain / etiology
  • Hypoxia, Brain / mortality
  • Infusions, Intravenous
  • Ketamine / administration & dosage
  • Ketamine / adverse effects
  • Ketamine / therapeutic use*
  • Male
  • Middle Aged
  • Propofol / administration & dosage
  • Propofol / adverse effects
  • Propofol / therapeutic use*
  • Retrospective Studies
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / mortality
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use
  • Young Adult

Substances

  • Anesthetics, Dissociative
  • Anesthetics, Intravenous
  • Vasoconstrictor Agents
  • Ketamine
  • Propofol