Status epilepticus treated by intravenous infusions of thiopentone sodium.

Brown, Allan S.; Horton, Jean M.

doi:10.1136/bmj.1.5531.27

Cited by 48 publications

(9 citation statements)

References 2 publications

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“…The association between serial epilepsy and status epilepticus is well known; the former often heralds the latter.3 Where the use of anticonvulsant drugs has been extensive, it is often difficult to say whether the coma between attacks is due to the epilepsy, the medication, or indeed both. 4 In this patient, the progressive severity of the attack was such that treatment was essential. He had had over sixty convulsions in the first 24 hours, these occurring both spontaneously and in response to stimuli.…”

Section: Discussionmentioning

confidence: 85%

A case of status epilepticus.

Feneck

1981

Anaesthesia

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SummaryA case of status epilepticus which was refractory to conventional anticonvulsants is described. The total dosage of thiopentone necessary to control the convulsions is greater than that previously recorded. The use of regular plasma estimation of thiopentone levels, and of cortical monitoring with the Cerebral Function Monitor (Ormed Engineering) is described, and is recommended where anticonvulsants are used for prolonged control of status epilepticus and in dosages greater than is common practice. Key words Brain; convulsions.Status epilepticus is a life-threatening condition, in which one convulsion follows another without recovery of consciousness. During the convulsions, cerebral oxygen and glucose requirements are increased, and, unless the convulsions are arrested, pyrexia or hyperpyrexia, hypotension, hypoglycaemia and the enhancement of cerebral arteriovenous oxygen and carbon dioxide differences will all combine to deepen the coma, and make death inevitable.'Treatment of status epilepticus is directed towards arresting the convulsions whilst maintaining adequate oxygenation and vital organ function. Artificial ventilation and muscle relaxation may be of benefit in this situation: but the use of muscle relaxants may prevent neuromuscular conduction and hence the clinically recognisable clonic phase of a fit. It is of advantage, therefore, to monitor cortical activity in order to show when the cerebral epileptic discharge is under control.A case description follows of a patient in whom conventional doses of anticonvulsants had failed to suppress the convulsions, and who required artificial ventilation. The use of cortical monitoring enabled the dosage of anticonvulsant to be pursued and adjusted to the point where cortical epileptic activity ceased. The dosage required was far in excess of expectation or previous experience. Case historyA 65-year-old man suffering from intermittent haematuria was admitted to hospital as an emergency following the passage of blood and clotsper urethram.The patient had a %-year history of epilepsy, and in 1956 he sustained a left-sided fracture of the skull and extradural haematoma following an epileptic attack. Since that time he had had several admissions to hospital for status epilepticus.

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Section: Discussionmentioning

confidence: 85%

A case of status epilepticus.

Feneck

1981

Anaesthesia

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“…Thiopentone was by far the most favoured anaesthetic agent in our survey, and indeed a substantial number also used it at subanaesthetic doses. The barbiturate anaesthetics have been used for many years in the treatment of status epilepticus and they have putative cerebroprotective action and potent anti-epileptic activity [34,35]. The main disadvantages, however, are in their pharmacokinetics.…”

Section: Discussionmentioning

confidence: 99%

“…Hypotension may occur and cardiac inotropes are often required. The favourable reports of subanaesthetic doses of thiopentone being used without ventilatory support should be interpreted cautiously and cannot be recommended [35,371. Pentobarbitone, which is one of the major metabolites of thiopentone, has a shorter half-life, but the published reports of its use in the treatment of status epilepticus are not encouraging [34,38,39].…”

Section: Discussionmentioning

confidence: 99%

The intensive care treatment of convulsive status epilepticus in the UK

Walker¹,

Smith

Shorvon³

1995

Anaesthesia

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“…Barbiturate Seit etwa 50 Jahren werden intravenös verabreichte Barbiturate zur Therapie des refraktären SE eingesetzt [20]. Allerdings wurden die meisten Patienten nur 2-3 Tage und mit subanästhetischen Dosen behandelt.…”

Section: Sedierende Antikonvulsiva Und Injektionsnarkotikaunclassified

“…Allerdings wurden die meisten Patienten nur 2-3 Tage und mit subanästhetischen Dosen behandelt. Dies erklärt die anfänglich berichtete niedrige Komplikationsrate [20]. Seit Beginn der 1980er Jahre ist das barbituratinduzierte Burst-suppression-Koma eine der am häufigsten angewandten Therapieformen des refraktären SE.…”

Section: Sedierende Antikonvulsiva Und Injektionsnarkotikaunclassified

Refractory status epilepticus

et al. 2006

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Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10-20/100,000 individuals. The overall mortality is about 10-20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.

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Status epilepticus treated by intravenous infusions of thiopentone sodium.

Cited by 48 publications

References 2 publications

A case of status epilepticus.

A case of status epilepticus.

The intensive care treatment of convulsive status epilepticus in the UK

Refractory status epilepticus

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