Isoflurane Inhalational Anesthesia for Refractory Status Epilepticus.
Abstract number :
2.135
Submission category :
Year :
2001
Submission ID :
254
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S. Mirsattari, MD, Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada; B. Young, MD, Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada; M. Sharpe, MD, Anesthesia, University of Western Ontario
RATIONALE: Refractory status epilepticus (RSE) has been described variably as continued seizures after 2 or 3 antiepileptic drugs (AEDs) have been tried. Anesthetic barbiturates were a usual resouce, but prolonged sedation and increased infections prompted examination of other agents. Recently midazolam and propofol have been championed. We review our experience with Isoflurane as an alternative approach.
METHODS: We reviewed our files of RSE patients treated with Isoflurane whose seizures had failed to stop after 3 AEDs. Patient follow-up, for Glasgow Coma Scale determination, was conducted 6 months or more after the episode of RSE.
RESULTS: Seven patients (4 males and 3 females) aged 17-71 years received Isoflurane for RSE. Isoflurane was initiated 1-102 (mean 19) days after the onset of status epilepticus. Five patients had received lorazepam, 6 phenytoin, 6 midazolam, 6 propofol and 3 thiopental before Isoflurane. Isoflurane stopped the seizures with a burst-suppression EEG pattern within 30 minutes in all cases. End-tidal Isoflurane concentration ranged from 1.2-5%; mean dose was 173 (range 12-277, SD 159) minimum alveolar concentration-hours. Four patients had a good outcome, 2 died (one of autopsy-proven acute hemorrhagic leukoencephalitis and one of ischemic bowel infarction) and one with toxic encephalopathy remained in persistent vegetative state until death at 5 months. All required vasopressors, inotropes or volume expansion for hypotension during Isoflurane treatment; successfully treated infections occurred in 6/7 (86%), paralytic ileus in 3/7 (43%) and cardiac arrhythmias in 2/7 (29%).
CONCLUSIONS: Isoflurane stopped RSE in all cases. Mortality and long-term morbidity related to underlying diseases. Others did well, although intra-ICU complications were common.