Abstracts

This is a Late Breaking abstract

Rationale: This study is aimed to compare the outcomes of ketamine use as a first-line intravenous anesthetic drug (IVAD) to treat refractory status epilepticus (RSE). To this date, there is no high-quality evidence or randomized trials to guide the treatment of RSE (level U). The current practice is to commence intravenous anesthetic drugs (IVADs) after the failure of other anti-epileptic agents. The conventional agents (propofol, midazolam, barbiturates) often come with the cost of mechanical ventilation requirement, cardiovascular depression, and a prolonged ICU stay which itself independently leads to increased morbidity and mortality. In that regard ketamine, is an attractive alternative it has sympathomimetic properties preserves respiratory drive, and promotes bronchodilation. However, there is only limited evidence for its use as a first-line agent, and recent clinical trials were terminated prematurely due to limited recruitment. We illustrate an intractable epilepsy case with 38 encounters due to refractory status epilepticus. Throughout her treatment patient received both conventional anesthetics and ketamine, we aimed to compare the outcomes of different treatment modalities.

Methods: We retrospectively reviewed electronic medical records for encounters related to RSE in which IVADs were used. 38 encounters fitting our criteria were analyzed to compare the outcomes of ketamine vs conventional IVADs to treat RSE. Hospital days were calculated from ED triage to the date of discharge from our center, while days spent in rehab were excluded. Statistical analysis was performed using PRISM software._x000D_ _x000D_ Results: A one-way ANOVA with Tukey HSD was used to compare the hospital duration among different IVADs (Figure 1). Ketamine monotherapy compared to propofol (p= < 0.0001, %95 CI = 8.5-21) and midazolam (p=0.002, CI = 2.5-13) significantly reduced the mean hospital duration F (4, 38) = [16.3], p < 0.0001. There was no statistical difference in hospital duration between ketamine monotherapy vs ketamine and midazolam combination therapy. A similar trend was also found in ICU duration, where ketamine use compared to significantly reduced ICU duration. _x000D_ _x000D_ Compared to conventional agents, ketamine monotherapy reduced intubation rates by 74% and ICU admission rates by 26%. The most frequently reported side effects of ketamine infusion was dissociative psychosis (30%), tachycardia (20%), and sialorrhea (15%)._x000D_