Status epilepticus ketamine

Dorandeu, F., Carpentier, P., Baubichon, D., Four, E., Bemabe, D., Burckhart, M., Lallement, G. (2005). Efficacy of the ketamine-atropine combination in the delayed treatment of soman-induced status epilepticus. Brain Res. 1051(1-2) 164—75. 

There are reports that diazepam can produce paradoxical excitability immediately after i.v. administration to humans and small animals. Although this paradoxical effect is not well described in horses, diazepam should be administered with caution to mature horses when used as a sole agent. It can be used as the sole agent for sedation and restraint in young foals. Diazepam is recommended for i.v. use at doses of 0.02-0.1 mg/kg. Diazepam is primarily used in adult horses to provide muscle relaxation and for its anticonvulsant effect prior to anesthetic induction with ketamine. Diazepam (0.04 mg/kg) reduces the MAC of halothane by approximately 29% (Matthews et al 1990). Diazepam is considered the acute treatment of choice for status epilepticus in all species (see Ch. 9). Diazepam (0.02-0.04 mg/kg) is an appetite stimulant in horses, although its effect is of short duration (Brown et al 1976). 

A 4-year-old previously healthy girl presented with new-onset seizures associated with fevers, headache, and malaise. She developed status epilepticus resistant to intravenous tenzodiaz-epines, fosphenytoin, levetiracetam, valproate, pentobarbital, and ketamine. An initial MRI brain scan was unremarkable. Isoflurane was begun, and an MRI scan 14 days later showed hyperintense T2 signals in the cerebellar vermis and cerebellar hemispheres. The isoflurane concentration was reduced to 0.5% and a further scan after 31 days of isoflurane therapy showed improvement in the signal abnormalities. Her isoflurane exposure was 1382% concentration-hours/1257 MAC-hours. She remained minimally conscious. 

Kramer AH. Early ketamine to treat refractory status epilepticus. Neurocrit Care 2012 16 299-305. 

Synowiec AS, Singh DS, Yenugadhati V, Valeriano JP, Schramke CJ, Kelly KM. Ketamine use in the treatment of reft actory status epilepticus. Epilepsy Res 2013 105 183-8. 

Gaspard N, Foreman B, Judd LM, Brenton JN, Nathan BR, McCoy BM, et al. Intravenous ketamine for the treatment of refractory status epilepticus a retrospective multicenter study. Epilepsia 2013 54 1498-503. 

---