Bowel ischemia: a rare complication of thiopental treatment for status epilepticus.
BACKGROUND
Refractory status epilepticus (RSE) treatment is usually performed with coma induction using an appropriate general anesthetic. Most frequent complications are represented by hypotension and infection. Other side-effects may however be encountered.


METHODS
We describe two patients suffering from acute bowel ischemia after thiopental (THP) treatment for RSE. A 73-year-old man with a complex-patial RSE following an acute stroke received THP (303 mg/kg over 48 h); 36 h after THP discontinuation, he presented abdominal tenderness and lactate elevation. Necrosis of the terminal ileum and colon was seen during surgical exploration; he deceased shortly thereafter. A 21 year-old woman had a cryptogenic de novo generalized-convulsive RSE resistant to 5 attempts of EEG burst-suppression. During the 6th attempt, after THP (840 mg/kg over 150 h) together with mild hypothermia, she developed an ileus with elevated serum lactate; caecum necrosis was observed during surgery. Hypernatremia, acidosis and hyperlactatemia heralded this complication in both patients.


CONCLUSIONS
In these two patients, mechanical vascular ischemia may have resulted from drug-induced paralytic ileus. To our knowledge, this is the first report describing this potential fatal side effect in adults with RSE.
Cereda
Carlo
C
Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CHUV BH-07, Lausanne, 1011, Switzerland.
Berger
Mette M
MM
Rossetti
Andrea O
AO
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D002432:Cecum / Q000098:blood supply*; D003106:Colon / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D013226:Status Epilepticus / Q000188:drug therapy*; D013874:Thiopental / Q000009:adverse effects*; D055815:Young Adult
D000927:Anticonvulsants; D013874:Thiopental