Isoflurane for Refractory Status Epilepticus

Kofke, W. Andrew; Young, Richard S.; Davis, Peter J.; Woelfel, S. K.; Gray, Leonard C.; Johnson, Dean; Gelb, Adrian W.; Meeke, R.; Warner, David O.; Pearson, Kent S.; Gibson, Jeff Ray; Koncelik, John; Wessel, Henry B.

doi:10.1097/00000542-198911000-00005

Cited by 145 publications

(79 citation statements)

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“…This idea receives further support from the abolishment of inhibition shown in the present study. Both results are surprising findings especially since isoflurane is frequently used for the treatment of status epilepticus at concentrations which induce BS (Kofke et al, 1985(Kofke et al, , 1989Meeke et al, 1989). This therapeutic effect probably relies on the ability of isoflurane to block gap junctions (Mantz et al, 1993), a primary instrument in the generalization of spike-wave seizures (Amzica et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Cortical Inhibition during Burst Suppression Induced with Isoflurane Anesthesia

Ferron¹,

Kroeger²,

Chever³

et al. 2009

J. Neurosci.

123

126

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Isoflurane is a widely used anesthetic which safely and reversibly induces deep coma and associated burst suppression (BS) electroencephalographic patterns. Here we investigate possible underlying causes for the state of cortical hyperexcitability which was recently shown to be one of the characteristics of BS. Our hypothesis was that cortical inhibition is diminished during isoflurane-induced BS. Experiments were performed in vivo using intracellular recordings of cortical neurons to assess their responsiveness to stimulations of connected thalamic nuclei. We demonstrate that during BS EPSPs were diminished by 44%, whereas inhibitory potentials were completely suppressed. This finding was supported by additional results indicating that a decrease in neuronal input resistance normally found during inhibitory responses under low isoflurane conditions was abolished in the BS condition. Moreover, removal of inhibition occasionally revealed excitatory components which were absent during recordings before the induction of BS. We also show that the absence of inhibition during BS is not caused by a blockage of GABA receptors, since iontophoretically applied GABA shows receptor availability. Moreover, the concentration of extracellular chloride was increased during BS, as would be expected after reduced flow of chloride through GABA A receptors. Also inhibitory responses were reinstated by selective blockage of glial glutamate transporters with dihydrokainate. These results suggest that the lack of inhibition during BS is caused by reduced excitation, probably resulting from increased glial uptake of glutamate stimulated by isoflurane, which creates a diminished activation of cortical interneurons. Thus cortical hyperexcitability during BS is favored by suppressed inhibition.

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Section: Discussionmentioning

confidence: 99%

Cortical Inhibition during Burst Suppression Induced with Isoflurane Anesthesia

Ferron¹,

Kroeger²,

Chever³

et al. 2009

J. Neurosci.

123

126

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“…In clinical work, BS pattern is most often seen during anesthesia, e.g., during treatment of status epilepticus [5,6] and children's intractable epilepsy [7J, when EEG is often monitored for days. In these cases BS EEG, especially the dynamics of burst and suppression segment lengths, is used as a criterion for the depth of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Adaptive segmentation of burst-suppression pattern in isoflurane and enflurane anesthesia

Lipping

Jäntti

Yli‐Hankala

et al. 1995

J Clin Monitor Comput

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In this paper a developed novel algorithm for adaptive segmentation of Burst-suppression EEG is presented. The algorithm can detect bursts, suppression and artifacts, dividing the signal into corresponding segments. A compact representation of burst-suppression EEG, useful in monitoring long-term recordings, is presented. In the second part of the paper the burst-suppression patterns of isoflurane and enflurane anesthesia are compared. It is found that bursts as well as suppression segments are shorter in enflurane anesthesia while the coefficient of variability of the segment lengths is similar for the two anesthetics.

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“…78 The largest case series to date of inhaled anesthetic in patients with status epilepticus included 9 patients, including 6 children. 79 Isoflurane was used for 1-55 hours and stopped the seizures in all the patients. However, seizures resumed on 8 of 11 occasions when isoflurane was discontinued.…”

Section: Clinical Indicationsmentioning

confidence: 99%

Inhaled Medical Gases: More to Breathe Than Oxygen

Gentile

2011

Respir Care

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Isoflurane for Refractory Status Epilepticus

Cited by 145 publications

References 0 publications

Cortical Inhibition during Burst Suppression Induced with Isoflurane Anesthesia

Cortical Inhibition during Burst Suppression Induced with Isoflurane Anesthesia

Adaptive segmentation of burst-suppression pattern in isoflurane and enflurane anesthesia

Inhaled Medical Gases: More to Breathe Than Oxygen

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