Abstracts

Rationale: To evaluate the risks of continuously administered i.v. anesthetic drugs (IVAD) on the outcome of adult patients with status epilepticus (SE), to determine their independence from confounders, such as etiology, severity, and duration of SE, as well as critical medical conditions.Methods: All ICU patients with SE from January 2005 to January 2011 at a tertiary academic medical care center were included. Severity of SE was graded by the Status Epilepticus Severity Score (STESS). Relative risks were calculated for the primary outcome measures of seizure control, Glasgow Outcome Scale at discharge, and death. Results: Of 171 patients, 37% were treated with (IVAD). Mortality was 18%. Patients with anesthetics had a higher proportion of infectious complications during SE (43% vs. 11%; p<0.0001) and a significant 3.2-fold relative risk for death (RR 3.16; 95%CI 1.54-6.51) independent of possible confounders (SE duration and severity, as well as critical medical conditions). Due to the collinearity between SE refractory to first- and second-line AEDs and the use of IVAD, no significant results could be detected between IVAD and outcome. In order to evaluate effect modification of the use of IVAD by the STESS variables defining SE severity and by etiologies, we fit interaction terms to the Poisson regression models to evaluate the associations with death. None of these interaction terms reached statistical significance. Conclusions: The use of anesthetic drugs in SE was associated with a high risk of death and a higher infection rate during SE. Our findings may heighten aware ness of the adverse effects of anesthetic drugs. Prospective randomized controlled trials are needed to further clarify the association of IVAD with outcome. Such associations should not influence therapeutic decisions as a paradigm for greater versus lesser intensity of seizure management has not been tailored to the significance of these possible associations.