Your nameFriend's name
Your emailFriend's email

Potential consequences of high-dose infusion of ketamine for refractory status epilepticus: case reports and systematic literature review

Department of Neurology, Department of Neurosurgery, NYU School of Medicine, New York, USA


Our goal was to provide comprehensive data on the effectiveness of ketamine in refractory status epilepticus (RSE) and to describe the potential consequences of long-term ketamine infusion. Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, blocks excitatory pathways contributing to ongoing seizure. While ketamine use is standard in anaesthetic induction, no definitive protocol exists for its use in RSE, and little is known about its adverse effects in long-term, high-dose administration. We present two cases of RSE that responded rapidly to ketamine infusion, both with fatal outcomes secondary to metabolic acidosis and cardiovascular collapse. We performed a systematic review of the application and consequences of ketamine use in RSE. PubMed, Ovid, MEDLINE and PMC were searched for articles describing ketamine treatment for RSE according to a predetermined search strategy and inclusion criteria. The systematic review revealed wide discrepancies in ketamine dosing (infusion maintenance dose range 0.0075–10.5 mg/kg/hour), but good outcomes in medically managed RSE (75% of studies reported moderate or complete seizure control in adults, 62.5% in paediatrics). Additionally, literature review elucidated a potentially causal relationship between prolonged ketamine infusion and both cardiovascular and metabolic dysregulation. Ketamine is effective in RSE by antagonising excitotoxic NMDA receptors. However, there is high variability in ketamine dosing and scarce data on its safety in long-term infusion. Metabolic acidosis and haemodynamic instability associated with the use of long-term, high-dose ketamine infusions must be of concern to clinicians administering ketamine to critically ill patients.

ASA member / Anaesthesia and Intensive Care subscriber

If you are a member of the ASA or subscribe to the Anaesthesia and Intensive Care Journal please login to view entire article.

Purchase 24-hour access

If you are not a member, you may purchase 24-hour access to the entire article by simply selecting your country and clicking the 'Purchase' button below.

Select your country:

Purchase a subscription

For unlimited access to all articles, you can subscribe to the Anaesthesia and Intensive Care Journal.