ArticleNeurocritical care2024
A Comparison of Ketamine and Midazolam as First-Line Anesthetic Infusions for Pediatric Status Epilepticus.
Article in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Ketamine for Analgosedation in Critically Ill Mechanically Ventilated Children: A Systematic Review and Meta-Analysis.Critical care explorations · 2026Pooled it
- The efficacy and safety of ketamine in the treatment of super-refractory status epilepticus: a systematic review.Journal of neurology · 2024Pooled it
- Therapeutic potential of ketamine after severe traumatic brain injury.Journal of intensive medicine · 2026Article
- Breaking the seizure cycle: Belgian expert consensus on the diagnostics and treatment of acute convulsive seizures in children.Acta neurologica Belgica · 2026Review
- Clinical utility and tolerability of ketamine as adjunctive rescue therapy for refractory neonatal status epilepticus: a case report of a late preterm infant with multifocal hemorrhagic brain injury.Frontiers in pediatrics · 2026Article
- Review
- Treatment considerations for the management of neonatal onset seizures.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2025Article
- Analgesia, Sedation, and Neuromuscular Blockade in Pediatric Severe Traumatic Brain Injury: Secondary Analysis of the "Approaches and Decisions in Acute Pediatric TBI Trial" (ADAPT).Neurocritical care · 2025Observational
- Ketamine in Status Epilepticus: How Soon Is Now?Neurology international · 2025Review
- Defining neonatal status epilepticus: A scoping review from the ILAE neonatal task force.Epilepsia open · 2025Article
- Treatment of convulsive status epilepticus in Brazil: a review.Arquivos de neuro-psiquiatria · 2025Review
- Ketamine for Status Epilepticus in Children: Searching for the Right Drug for the Right Patient.Neurocritical care · 2024Article
- Neonatal status epilepticus: critical issues in clinical practice.Frontiers in neurologyArticle
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundPediatric 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.
methodsRetrospective 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.
resultsWe 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 < 0.01). Adverse effects occurred more often in study participants administered midazolam (24%, 20/79) than ketamine (3%, 1/38; OR 12.54, 95% CI 1.61-97.43; P = 0.016). Study participants administered ketamine were younger, ketamine was used more often for children with acute symptomatic seizures, and midazolam was used more often for children with epilepsy. Multivariable logistic regression of seizure termination by first-line anesthetic infusion (ketamine or midazolam) including age at SE onset, SE etiology category, and individual seizure duration at anesthetic infusion initiation indicated seizures were more likely to terminate following ketamine than midazolam (OR 4.00, 95% CI 1.69-9.49; P = 0.002) and adverse effects were more likely following midazolam than ketamine (OR 13.41, 95% CI 1.61-111.04; P = 0.016). Survival to discharge was higher among study participants who received midazolam (82%, 65/79) than ketamine (55%, 21/38; P = 0.002), although treating clinicians did not attribute any deaths to ketamine or midazolam.
conclusionsAmong children and neonates with RSE, ketamine was more often followed by seizure termination and less often associated with adverse effects than midazolam when administered as the first-line anesthetic infusion. Further prospective data are needed to compare first-line anesthetics for RSE.
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