Propofol and barbiturates for the anesthesia of refractory convulsive status epilepticus: pros and cons.
OBJECTIVE
To discuss mainly the use of propofol and barbiturates in the anesthesia of refractory status epilepticus (RSE).


METHODS
Review of literature.


RESULTS
There are no prospective, randomized works comparing the effects of anesthetics in the treatment of RSE. Recently, the use of propofol has increased in the treatment of RSE. Propofol terminates both clinical and electric seizures quickly, but the maintenance of burst-suppression EEG pattern requires repetitive titration of doses. Relapses of seizures have occurred in 19-33% of patients, especially when tapering of dose. The advantages of barbiturates are lower frequency of short-term treatment failures, breakthrough seizures and changes to a different anesthetic agent. On the other hand, prolonged recovery leads to prolonged duration of mechanical ventilation, intensive care and hospital stay.


CONCLUSIONS
The use of propofol, barbiturates or midazolam in the anesthesia of RSE can be justified. When using propofol, the duration of high doses should be limited to 48 hours and the risk of propofol infusion syndrome should be kept in mind. High doses of barbiturates terminate effectively seizures but recovery from anesthesia prolongs ventilator treatment and intensive care.
Parviainen
Ilkka
I
Department of Anesthesiology and Intensive Care, Kuopio Epilepsy Center, Kuopio University Hospital, Kuopio, Finland. ilkka.parviainen@kuh.fi
Kälviäinen
Reetta
R
Ruokonen
Esko
E
D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D001463:Barbiturates / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000503:physiopathology; D012640:Seizures / Q000188:drug therapy* / Q000503:physiopathology; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology; D015300:Ventilator Weaning
D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D001463:Barbiturates; D008874:Midazolam; D015742:Propofol