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Ketamine for benzodiazepine refractory seizures

Should ketamine be used earlier on in acute seizure management? Current guidelines, including the most recent updated APLS guidelines does not mention ketamine. Most of the current literature supports its use in refractory status epilepticus (SE) outside initial paediatric emergency department (PED) management; after failures of initial benzodiazepines and second-line treatment. Ketamine is usually used as a continual infusion once intubated and on intensive care. Buratti S et al [Epilepsia 2023:1–14.] have written a great review of the management of status epilepticus with a focus on the pharmacology. They produce a good argument for the use of ketamine as an advanced second-line treatment in benzodiazepine-refractory convulsive status epilepticus in children. It’s a useful review and focuses on the pharmacological targets in SE and antiepileptic medications (AED) modes of action, the pathophysiology of SE and the receptor trafficking hypothesis, the pharmacology of ketamine, the experimental evidence on the use of ketamine in SE and the potential clinical role of ketamine in SE treatment. Lucina looks forward to the results of the randomised controlled studies in the pipeline.

Ever been bitten by a scorpion?

Lucina has and it hurts! We don’t have scorpions in the UK but no doubt there will be people who keep them as pets. …

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