Thiamylal anaesthetic therapy for febrile refractory status epilepticus in children

Abstract

To evaluate barbiturate anaesthetic therapy using thiamylal for febrile refractory status epilepticus (fRSE) in children. Methods: This was a review of a prospectively-collected database between April 2012-March 2016 for fRSE cases treated with thiamylal anaesthetic therapy in a single paediatric hospital in Japan. The sample comprised 23 children (median age, 23 months) with fRSE that underwent thiamylal anaesthetic therapy for convulsive seizures lasting longer than 60 min, sustained after intravenous administration of benzodiazepine and non-benzodiazepine anticonvulsants. The intervention comprised protocol-based thiamylal anaesthetic therapy with bolus administration. We measured the dose and time required to achieve the burst suppression pattern (BSP) on electroencephalography, seizure recurrence, death, neurological sequelae, and complications. Results: All patients except one reached the BSP. The thiamylal median dose until reaching the BSP was 27.5 mg/kg, and the median time from thiamylal administration to reaching the BSP was 109.5 min. There was one case of immediate treatment failure and one of withdrawal seizure, but no breakthrough seizure. No deaths occurred during treatment, and neurological sequelae occurred in four cases (17%). Vasopressors were administered in all cases. Other complications included 11 cases of pneumonia and one of enterocolitis. Conclusion:We revealed the time and dose required to reach the BSP with thiamylal anaesthetic therapy using bolus administration in children. Our results suggested that reaching the BSP with bolus administration requires markedly less time than without bolus administration, rarely causes seizure recurrence in paediatric fRSE, and causes haemodynamic dysfunction and infections as often as observed without bolus administration.

Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia

“…Recently, we have paid attention to thiamylal because the drug was reported to be ultra-short-acting, has fewer cardiovascular side effects, and has more potent than thiopental. 14) Moreover, thiamylal is widely used for sedation in children in Japan. 6 , 7 , 15) Therefore, we believe that thiamylal is a good candidate drug to provide novel protective findings of prophylactic barbiturate in patients with sTBI.…”

Comparison of neurological manifestation in children with and without coronavirus 2019 experiencing seizures with fever

“…Seizure duration was the time between seizure onset, according to information from caregivers, and seizure cessation, as confirmed by physicians [19] . Convulsive seizure duration was the duration of a persistent convulsion or a sequence of intermittent convulsions without full recovery of consciousness between convulsions [20] . The seizure type was defined as focal, generalized, and unknown onset according to the International League Against Epilepsy classification [21] .…”

Stepdown Infusion of Barbiturate improves Neurological Function in a New Rat Model of Rebleeding Subarachnoid Hemorrhage.

“…[10][11][12] Among them, we selected thiamylal regarding the ultra-short acting and fewer cardiovascular complication, and stronger potentiation than thiopental. 5,13 Then, we previously explore a novel administration method, sd-B, which could keep a stable concentration of thiamylal, reduction of side effects such as pneumonia and arrhythmia and provided good prognosis in the patients with severe traumatic brain injuries. 4,5 Rebleeding is supposed to produce repeated ICP elevation and subsequent severe CBF reduction, and also additive subarachnoid blood clot enhances oxidative stress and in ammatory response.…”