Ketamine-dexmedetomidine combination and controlled mild hypothermia for the treatment of long-lasting and super-refractory status epilepticus in 3 dogs suffering from idiopathic epilepsy

Objective - To describe the use of ketamine-dexmedetomidine combination for the treatment of status epilepticus in 3 dogs that did not respond to GABA-ergic medication. Case series summary – Three dogs with diagnosis of idiopathic epilepsy were presented to the emergency department in status epilepticus. Dogs were treated unsuccessfully with benzodiazepine as a first line therapy, followed by propofol intravenous anesthesia maintained for at least 12 hours. When general anesthesia was discontinued seizure recurred. All patients, then received a bolus of ketamine (1 mg/kg IV) over a period of 5 minutes followed by a bolus of dexmedetomidine (3μg/kg IV) over the same time. Both drugs were infused for 12 hours at a constant rate of 1 mg/kg/h for ketamine and at a variable rate of 3-7 μg/kg/h for dexmedetomidine. The dogs recovered uneventfully over the next 48 hours after treatment discontinuation with no evidence of seizure. No remarkable alteration in physiological parameters were observed during infusion. All dogs were discharged with negative neurological examination. New or unique information provided – This case series highlights the potential benefit of ketamine-dexmedetomidine infusion for the treatment of status epilepticus refractory to GABA-ergic therapy in dogs suffering from idiopathic epilepsy. After weaning from ketamine-dexmedetomidine infusion all dogs experienced a complete recovery. This case series introduces a novel, safe and effective approach to this dramatic condition.