Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus

Abstract

Status epilepticus that cannot be controlled with first- and second-line agents is called refractory status epilepticus (RSE), a condition that is associated with significant morbidity and mortality. Most experts agree that treatment of RSE necessitates the use of continuous infusion intravenous anesthetic drugs such as midazolam, propofol, pentobarbital, thiopental, and ketamine, each of which has its own unique characteristics. This review compares the various anesthetic agents while providing an approach to their use in adult patients, along with possible associated complications.

Duration of therapeutic coma and outcome of refractory status epilepticus

“…T 2 is the second time point at which the dose of anesthetic started to develop a significant downward trend, defined by a drop of at least 20% of the hourly infusion rate in three subsequent hours and an ultimate endpoint of 0 (Figure ). Similar to prior studies comparing the efficacy and safety of different anesthetics, the maximum steady dose of anesthetic was converted to a time‐ and weight‐based unit (µg/kg/min) across all anesthetic agents utilized in the first trial of TC …”

“…Similar to prior studies comparing the efficacy and safety of different anesthetics, the maximum steady dose of anesthetic was converted to a time-and weight-based unit (µg/kg/min) across all anesthetic agents utilized in the first trial of TC. 8,13,14,18,19 The primary outcome was recurrence of seizure activity either on EEG or clinical presentation within 48 hours of initiation of anesthetic taper (ie, time point T 2 ), which has been described as withdrawal seizures in the literature. 14 Secondary outcomes focused on mortality and morbidity associated with the admission for treatment of RSE.…”

“…3,6,7 TC carries risks related to intubation, intensive care unit (ICU) stay, and anesthetic side effects. 8 There is ongoing controversy as to whether TC is an independent risk factor for prolonged hospitalizations, infection risk, poor functional outcomes, and in-hospital mortality. [9][10][11][12] To date, most studies looking at TC as treatment for RSE have been retrospective, with one prospective, randomized clinical trial that was undersampled due to lack of enrollment.…”

Epilepticheskiy Status: Realnost 2019

“…Общие анестетики используются при рефрактерном ЭС, то есть при длительности ЭС более 60 минут и неэффективности бензодиазепинов и антиэпилептических препаратов. Рефрактерный ЭС развивается в 9-43 % случаев (37). Применение анестетиков требует проведения ИВЛ, мониторинга и интенсивной терапии в условиях реанимации.…”

Die Therapie und Prognose des refraktären und super-refraktären Status epilepticus

“…Der größte Kritikpunkt an diesen retrospektiven Kohorten ist die Vermutung, dass doch inhärent Unterschiede zwischen den Gruppen bestanden haben könnten, obwohl sich die Autoren große Mühe gaben, "confounders" zu berücksichtigen. Es ist schwierig vollkommen auszuschließen, dass die behandelnden Ärzte doch Anästhetika häufiger oder in anderen Dosierungen schwerer betroffenen Patienten verabreicht haben [16]. Somit wird auch in dieser Frage der dringende Bedarf an randomisierten und prospektiven Therapiestudien beim Status epilepticus deutlich, bevor die Ergebnisse unkritisch in klinische Behandlungspfade aufgenommen werden.…”