A Comparison of Ketamine and Midazolam as First-Line Anesthetic Infusions for Pediatric Status Epilepticus

Background Pediatric refractory status epilepticus (RSE) often requires management with anesthetic infusions, but few data compare first-line anesthetics. This study aimed to compare the efficacy and adverse effects of midazolam and ketamine infusions as first-line anesthetics for pediatric RSE. Met...

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Bibliographic Details
Published in:Neurocritical care 2024-06, Vol.40 (3), p.984-995
Main Authors: Jacobwitz, Marin, Mulvihill, Caitlyn, Kaufman, Michael C., Gonzalez, Alexander K., Resendiz, Karla, Francoeur, Conall, Helbig, Ingo, Topjian, Alexis A., Abend, Nicholas S.
Format: Article
Language:English
Subjects:
Adolescent
Blood pressure
Child
Child, Preschool
Convulsions & seizures
Critical care
Critical Care Medicine
Delirium
Electroencephalography
Electronic health records
Epilepsy
Female
Humans
Hypertension
Hypotension
Infant
Infant, Newborn
Infusions, Intravenous
Intensive
Internal Medicine
Ketamine
Ketamine - administration & dosage
Ketamine - adverse effects
Male
Medical records
Medicine
Medicine & Public Health
Midazolam - administration & dosage
Midazolam - adverse effects
Neurology
Neurosurgery
Original Work
Pediatrics
Retrospective Studies
Status Epilepticus - drug therapy
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Summary:Background Pediatric refractory status epilepticus (RSE) often requires management with anesthetic infusions, but few data compare first-line anesthetics. This study aimed to compare the efficacy and adverse effects of midazolam and ketamine infusions as first-line anesthetics for pediatric RSE. Methods Retrospective single-center study of consecutive study participants treated with ketamine or midazolam as the first-line anesthetic infusions for RSE at a quaternary care children’s hospital from December 1, 2017, until September 15, 2021. Results We identified 117 study participants (28 neonates), including 79 (68%) who received midazolam and 38 (32%) who received ketamine as the first-line anesthetic infusions. Seizures terminated more often in study participants administered ketamine (61%, 23/38) than midazolam (28%, 22/79; odds ratio [OR] 3.97, 95% confidence interval [CI] 1.76–8.98; P  
ISSN:1541-6933
1556-0961
1556-0961
DOI:10.1007/s12028-023-01859-2