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Modern Inhalational Anesthetics for Refractory Status Epilepticus

  • Frederick A. Zeiler (a1) (a2), Kaitlin J. Zeiler (a2), Jeanne Teitelbaum (a2) (a3), Lawrence M. Gillman (a4) (a5) and Michael West (a1)...

Abstract

Background: Our goal was to perform a systematic review of the literature on the use of modern inhalational anesthetic agents for refractory status epilepticus and their impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to March 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology by two independent reviewers. Results: Overall, 19 studies were identified, with 16 manuscripts and 3 meeting abstracts. A total of 46 patients were treated. Adult (n=28) and pediatric patients (n=18) displayed 92.9% and 94.4% seizure control with treatment, respectively. Isoflurane was used in the majority of cases. Hypotension was the only complication described. Conclusions: Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence exists to support the use of isoflurane in refractory status epilepticus to obtain burst suppression. Insufficient data exist to comment on the efficacy of desflurane and xenon at this time.

Anesthésiques modernes administrés par inhalation dans le status epilepticus réfractaire au traitement. Contexte: Nous avons effectué une revue systématique de la littérature concernant l’utilisation des anesthésiques modernes administrés par inhalation aux patients en status epilepticus réfractaire au traitement et leur impact sur le contrôle des crises. Méthodes: Nous avons recherché tous les articles pertinents dans MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (de sa création à mars 2014), les listes de références d’articles pertinents ainsi que dans la documentation parallèle. La qualité des études a été déterminée par deux réviseurs indépendants au moyen de deux méthodologies, soit celle du groupe d’Oxford et la Grading of Recommendation Assessment Development and Education. Résultats: Au total, 19 études ont été identifiées dont 16 étaient des manuscrits et 3 étaient des résumés de congrès. Quarante-six patients avaient été traités au moyen d’anesthésiques par inhalation, dont 28 adultes et 18 patients d’âge pédiatrique et chez 92,9% et 94,4% d’entre eux respectivement, le traitement a contrôlé le status epilepticus. L’isoflurane a été utilisé dans la majorité des cas. L’hypotension a été la seule complication rapportée. Conclusions: Des données de niveau 4 selon la méthode d’Oxford et de niveau D selon le Grading of Recommendation Assessment Development and Education existent à l’appui de l’utilisation de l’isoflurane chez les patients présentant un status epilepticus réfractaire au traitement pour parvenir à une suppression des salves. Il n’existe pas actuellement suffisamment de données pour évaluer l’efficacité du desflurane ou du xénon.

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Copyright

Corresponding author

Correspondence to: Frederick A. Zeiler, GB-1 820 Sherbrook Street, Health Sciences Center, Winnipeg, Manitoba, Canada R3A1R9. Email: umzeiler@cc.umanitoba.ca

References

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Modern Inhalational Anesthetics for Refractory Status Epilepticus

  • Frederick A. Zeiler (a1) (a2), Kaitlin J. Zeiler (a2), Jeanne Teitelbaum (a2) (a3), Lawrence M. Gillman (a4) (a5) and Michael West (a1)...

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