Pentobarbital therapy for status epilepticus in children: timing of tapering.
Three children with refractory status epilepticus, unresponsive to intravenous administration of diazepam, phenytoin, and lidocaine, received pentobarbital therapy and were monitored by electroencephalography (EEG). They required mechanical ventilation and vasopressor therapy. Intravenous pentobarbital therapy was successful and without distinct sequelae in all 3 patients, and could be incrementally discontinued without breakthrough seizures after 12-65 hours of a burst-suppression or complete suppression pattern on EEG. Obtaining a suppression pattern was important for controlling status epilepticus in children as well as adults. We suggest that 12 hours after a burst-suppression pattern is obtained, tapering of pentobarbital should be attempted to avoid serious complications of extended pentobarbital anesthesia (e.g., respiratory depression, hypotension, pneumonia).
Department of Child Neurology, National Center Hospital for Mental, Nervous, and Muscular Disorder, Tokyo, Japan.
H
H
Kinoshita
E
E
Nakagawa
Y
Y
Iwasaki
S
S
Hanaoka
K
K
Sugai
D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010424:Pentobarbital / Q000008:administration & dosage* / Q000009:adverse effects; D013226:Status Epilepticus / Q000188:drug therapy*
D000927:Anticonvulsants; D010424:Pentobarbital