تأثیر کتامین بر کنترل تشنج مداوم در اطفال
مجله انجمن آنستزیولوژی و مراقبتهای ویژه ایران,
دوره 2 شماره 118 (1401),
14 October 2023
چکیده
تشنج مداوم یکی از اورژانسهای شایع نرولوژیک در کودکان میباشد. تابحال درمان قطعی و مشخصی برای تشنجهای مداوم مقاوم به درمان با بنزودیازپینها یا سایر داروهای ضد تشنج ارائه نشده است. پروتکلهای متفاوتی بعنوان خط دوم درمان بعد از بنزودیازپینها معرفی شده که شامل فنیتوئین، والپرات سدیم، لووتیراستام، باربیتوراتها و پروپوفول میباشد. در صورت شکست درمان در خط اول (بنزودیازپینها) یا خط دوم (سایر داروهای ضدتشنج) کتامین با دوز بولوس 1mg/kg و سپس انفوزیون 2 mg/kg/h تا حداکثر7 mg /kg/h همراه با سایر داروها توصیه میشود. کتامین یک آنتاگونیت غیر رقابتی گیرنده ان متیل دی آسپارتات (NMDA) است که با اثرات محافظتی از نرونها و خواص ضدالتهابی و ضد اپی لپسی در خط دوم و سوم سبب کنترل تشنج میگردد. ما با مرور چند مقاله به نقش بالقوه کتامین در درمان تشنج مقاوم به درمان به عنوان خط دوم و سوم پی بردیم و به این نتیجه رسیدیم که بهترین روش درمان تشنجهای مداوم، شروع درمان به موقع، استفاده چند دارویی بجای تک دارویی و انتخاب داروهای با اثرات محافظتی نرون با کمترین عارضه جانبی میباشد. بنابراین به نظر میرسد استفاده از کتامین با سایر داروها این برای کنترل تشنج مؤثر است.- آرامبخشی ، اندوسکوپی، پروپوفول، کتامین، لیدوکایین وریدی
- الکتروشوک درمانی؛ اسمولول؛ طول مدت تشنج؛ زمان ریکاوری؛ همودینامیک
- پرهمدیکاسیون، کلونیدین، میدازولام، کودکان، درد، اضطراب
ارجاع به مقاله
مراجع
Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, Bare M, Bleck T, Dodson WE, Garrity L, Jagoda A. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy currents. 2016 Jan;16(1):48-61.
Trinka E, Cock H, Hesdorffer D et al. A definition and classification of status epilepticus—report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia . 2015;56(10):1515–1523. [PubMed] [Google Scholar]
Kapur J, Elm J, Chamberlain JM, Barsan W, Cloyd J, Lowenstein D, Shinnar S, Conwit R, Meinzer C, Cock H, Fountain N. Randomized trial of three anticonvulsant medications for status epilepticus. New England Journal of Medicine. 2019 Nov 28;381(22):2103-13.
Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatric neurology. 2008 Jun 1;38(6):377-90.
- Loddenkemper T, Goodkin HP. Treatment of pediatric status epilepticus. Current treatment options in neurology. 2011 Dec;13(6):560-73.
- Dubey D, Kalita J, Misra UK. Status epilepticus: Refractory and super-refractory. Neurology India. 2017 Mar 1;65(7):12.
- Vasquez A, Farias-Moeller R, Tatum W. Pediatric refractory and super-refractory status epilepticus. Seizure. 2019 May 1;68:62-71.
- Samanta D, Garrity L, Arya R. Refractory and super-refractory status epilepticus. Indian pediatrics. 2020 Mar;57:239-53.
- Arayakarnkul P, Chomtho K. Treatment options in pediatric super-refractory status epilepticus. Brain and Development. 2019 Apr 1;41(4):359-66.
- Fernández IS, Abend NS, Agadi S, An S, Arya R, Carpenter JL, Chapman KE, Gaillard WD, Glauser TA, Goldstein DB, Goldstein JL. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014 Feb 1;23(2):87-97.
- Mori K, Maeda M, Miyazaki M, Iwase H. Misery perfusion caused by cerebral hypothermia improved by vasopressor administration. Neurological research. 1999 Sep 1;21(6):585-92.
- De Visscher G, Borgers M, Reneman RS, Flameng W, van Rossem K. Assessment of saturation with oxygen of cerebral venous blood and estimation of the cerebral metabolic rate of oxygen in rats using near infrared spectroscopy. Application and validation of near infrared-spectroscopy to monitor cerebral oxygenation, perfusion and metabolism in the rat. 2002 Jun 27:111.
- Tichauer KM, Hadway J, Lee TY, Lawrence KS. Near-infrared spectroscopy measurement of cerebral oxidative metabolism: A validation study. Journal of Cerebral Blood Flow & Metabolism. 2005 Aug;25(1_suppl):S88
- De Visscher G, Rooker S, Blockx H, Jorens P, Verlooy J, Borgers M, Reneman RS, van Rossem K, Flameng W. Failure of pentobarbital to reduce cerebral oxygen consumption in rats after non-haemorrhagic closed head injury. Journal of Cerebral Blood Flow & Metabolism. 2005 Aug;25(1_suppl):S575
- Kohtala S. Ketamine—50 years in use: from anesthesia to rapid antidepressant effects and neurobiological mechanisms. Pharmacological Reports. 2021 Apr;73(2):323-45.
- Niesters M, Martini C, Dahan A. Ketamine for chronic pain: risks and benefits. British journal of clinical pharmacology. 2014 Feb;77(2):357-67.
- Natoli S. The multiple faces of ketamine in anaesthesia and analgesia. Drugs in Context. 2021;10.
- Shah SP, Patel D, Irungu A. Application of Ketamine in Current Practice of Anesthesiology.
-Fujikawa DG. Prolonged seizures and cellular injury: understanding the connection. Epilepsy & behavior. 2005 Dec 1;7:3-11.
- Marrero-Rosado BM, de Araujo Furtado M, Kundrick ER, Walker KA, Stone MF, Schultz CR, Nguyen DA, Lumley LA. Ketamine as adjunct to midazolam treatment following soman-induced status epilepticus reduces seizure severity, epileptogenesis, and brain pathology in plasma carboxylesterase knockout mice. Epilepsy & Behavior. 2020 Oct 1;111:107229.
- Sabharwal A, Schniter P, Guo D, Bliss DW, Rangarajan S, Wichman R. In-band full-duplex wireless: Challenges and opportunities. IEEE Journal on selected areas in communications. 2014 Jun 12;32(9):1637-52.
- Alkhachroum A, Appavu B, Egawa S, Foreman B, Gaspard N, Gilmore EJ, Hirsch LJ, Kurtz P, Lambrecq V, Kromm J, Vespa P. Electroencephalogram in the intensive care unit: a focused look at acute brain injury. Intensive care medicine. 2022 Oct;48(10):1443-62.
- Eldufani J, Blaise G. The role of acetylcholinesterase inhibitors such as neostigmine and rivastigmine on chronic pain and cognitive function in aging: A review of recent clinical applications. Alzheimer's & Dementia: Translational Research & Clinical Interventions. 2019 Jan 1;5:175-83.
- Eldufani J, Nekoui A, Blaise G. Nonanesthetic effects of ketamine: a review article. The American journal of medicine. 2018 Dec 1;131(12):1418-24.
- Pribish A, Wood N, Kalava A. A review of nonanesthetic uses of ketamine. Anesthesiology research and practice. 2020 Apr 1;2020.
- Wasterlain CG, Fujikawa DG, Penix L, Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 1993 Jan;34:S37-53.
- Zhong X, He H, Zhang C, Wang Z, Jiang M, Li Q, Zhang M, Huang X. Mood and neuropsychological effects of different doses of ketamine in electroconvulsive therapy for treatment-resistant depression. Journal of affective disorders. 2016 Sep 1;201:124-30.
- Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, Shorvon S, Lowenstein DH. A definition and classification of status epilepticus–Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015 Oct;56(10):1515-23.
- Loots H, Wiseman R. Agents for sedation in ophthalmic surgery: a review of the pharmacodynamics and clinical applications. Current Anaesthesia & Critical Care. 2006 Jan 1;17(3-4):179-90.
- Vuyk J, Sitsen E, Reekers M. Intravenous anesthetics. Miller’s anesthesia. 2015;8:858.
- Aurangzeb S, Prisco L, Adcock J, Speirs M, Raby S, Westbrook J, Sen A. New-onset super refractory status epilepticus: A case-series. Seizure. 2020 Feb 1;75:174-84.
- Málek J, Ševčík P, Bejšovec D, Gabrhelík T, Hnilicová M, Křikava I, Mixa V. Postoperative pain management. Prague, Czech Republic: Mladá fronta. 2017;1(1):102-11.
- Meehan TJ, Bryant SM, Aks SE. Drugs of abuse: the highs and lows of altered mental states in the emergency department. Emergency Medicine Clinics. 2010 Aug 1;28(3):663-82.
- Carr E. Barriers to effective pain management. Journal of Perioperative Practice. 2007 May;17(5):200-8.
- Buratti S, Giacheri E, Palmieri A, Tibaldi J, Brisca G, Riva A, Striano P, Mancardi MM, Nobili L, Moscatelli A. Ketamine as advanced second‐line treatment in benzodiazepine‐refractory convulsive status epilepticus in children. Epilepsia. 2023 Apr;64(4):797-810.
- Walker MC, Howard RS, Smith SJ, Miller DH, Shorvon SD, Hirsch NP. Diagnosis and treatment of status epilepticus on a neurological intensive care unit. QJM: An International Journal of Medicine. 1996 Dec 1;89(12):913-20.
- Erstad BL, Patanwala AE. Ketamine for analgosedation in critically ill patients. Journal of critical care. 2016 Oct 1;35:145-9.
- Fang Y, Wang X. Ketamine for the treatment of refractory status epilepticus. Seizure. 2015 Aug 1;30:14-20.
- Dorandeu F, Dhote F, Barbier L, Baccus B, Testylier G. Treatment of status epilepticus with ketamine, are we there yet?. CNS Neuroscience & Therapeutics. 2013 Jun;19(6):411-27.
- Dorandeu F, Dhote F, Barbier L, Baccus B, Testylier G. Treatment of status epilepticus with ketamine, are we there yet?. CNS Neuroscience & Therapeutics. 2013 Jun;19(6):411-27.
- Green SM, Coté CJ. Ketamine and neurotoxicity: clinical perspectives and implications for emergency medicine. Annals of emergency medicine. 2009 Aug 1;54(2):181-90.
- Morris PJ, Burke RD, Sharma AK, Lynch DC, Lemke-Boutcher LE, Mathew S, Elayan I, Rao DB, Gould TD, Zarate Jr CA, Zanos P. A comparison of the pharmacokinetics and NMDAR antagonism-associated neurotoxicity of ketamine,(2R, 6R)-hydroxynorketamine and MK-801. Neurotoxicology and Teratology. 2021 Sep 1;87:106993.
- Strebel S, Kaufmann M, Maire L, Schaefer HG. Effects of ketamine on cerebral blood flow velocity in humans Influence of pretreatment with midazolam or esmolol. Anaesthesia. 1995 Mar;50(3):223-8.
- Bachula L, Kumar SS, Shiva PV. A comparative study of intravenous infusion of ketamine-propofol and ketamine-dexmedetomidine for deep sedation and analgesia in pediatric patients undergoing day care surgeries at niloufer hospital. Journal of Cellular & Molecular Anesthesia. 2018;8(1):48-60.
- Buratti S, Giacheri E, Palmieri A, Tibaldi J, Brisca G, Riva A, Striano P, Mancardi MM, Nobili L, Moscatelli A. Ketamine as advanced second‐line treatment in benzodiazepine‐refractory convulsive status epilepticus in children. Epilepsia. 2023 Apr;64(4):797-810.
- Sehdev RS, Symmons DA, Kindl K. Ketamine for rapid sequence induction in patients with head injury in the emergency department. Emergency Medicine Australasia. 2006 Feb;18(1):37-44.
- چکیده مشاهده شده: 91 بار