Treatment of refractory status epilepticus with intravenous anesthetic agents: A systematic review

This systematic review aimed to visualize the existing anesthetic options for treatment of refractory status epilepticus (RSE) to propose a research program in this area. The following keywords (Title/Abstract) were used in Scopus and MEDLINE databases: “Anesthetics” OR “Anesthetic Agents” OR “Anesthetic Drugs” AND “Status Epilepticus” OR “Refractory Status Epilepticus” OR “Refractory Seizures” OR “SE” OR “RSE”. The primary search yielded 6717 articles. Of these, a total of 50 studies met all inclusion criteria and included in the current systematic review. Most studies have reported the effectiveness of midazolam, barbiturates, ketamine, and propofol in the treatment of RSE. While RSE is a neurological emergency with a significant risk of death and neuronal damages, limited evidences are available to choose the right treatment option. Ketamine has been shown to be effective in the treatment of RSE and because it has no adverse effect on the patients’ cardiovascular system, it could be a potential candidate for use in future clinical trials in this field. However, the available studies are limited to retrospective studies, which make it impossible to draw any firm conclusion. Further prospective randomized trials are needed to provide high evidence of ketamine efficacy in the treatment of RSE.