Which anesthetic should be used in the treatment of refractory status epilepticus?
While the treatment of refractory status epilepticus (SE) relies on the use of anesthetic agents, mostly barbiturates, propofol, or midazolam, the study of the available literature discloses that the evidence level is low. Therapeutic coma induction appears straightforward for generalized convulsive or subtle SE, but this approach is debated for complex partial SE. Each anesthetic has its own advocates, and specific advantages and risks; furthermore, several different protocols have been reported regarding the duration and depth of sedation. However, it seems that the biological background of the patient (especially the etiology) remains the main prognostic determinant in SE. There is a clear need of controlled trials regarding this topic.
Rossetti
Andrea O
AO
Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. andrea.rossetti@chuv.ch
D000777:Anesthetics / Q000494:pharmacology / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D001463:Barbiturates / Q000627:therapeutic use; D003128:Coma / Q000139:chemically induced; D004569:Electroencephalography / Q000187:drug effects; D005544:Forecasting; D006801:Humans; D008874:Midazolam / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015742:Propofol / Q000627:therapeutic use; D013226:Status Epilepticus / Q000188:drug therapy*
D000777:Anesthetics; D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D001463:Barbiturates; D008874:Midazolam; D015742:Propofol