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VOLUME 19 , ISSUE 5 ( 2015 ) > List of Articles

BRIEF COMMUNICATION

Complications during the management of pediatric refractory status epilepticus with benzodiazepine and pentobarbital infusions

Andre Raszynski, Balagangadhar R. Totapally, William Patten, Sayed Z. Naqvi

Keywords : Child, pediatric intensive care unit, status epilepticus, seizures

Citation Information : Raszynski A, Totapally BR, Patten W, Naqvi SZ. Complications during the management of pediatric refractory status epilepticus with benzodiazepine and pentobarbital infusions. Indian J Crit Care Med 2015; 19 (5):275-277.

DOI: 10.4103/0972-5229.156476

License: CC BY-ND 3.0

Published Online: 00-05-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The objective of this retrospective study was to evaluate complications in the management of refractory status epilepticus (RSE) treated with benzodiazepine and pentobarbital infusions. Of 28 children with RSE, eleven (39%) were treated with a pentobarbital infusion after failure to control RSE with a benzodiazepine infusion; while17 children (61%) required only a benzodiazepine infusion. The mean maximum pentobarbital infusion dosage was 5.2 ± 1.8 mg/kg/h. Twenty-five patients received a continuous midazolam infusion with an average dosage of 0.41 ± 0.43 mg/kg/h. The median length of stay was longer for the pentobarbital group. Children requiring pentobarbital therapy were more likely to develop hypotension, require inotropic support, need intubation, mechanical ventilation, peripheral nutrition, and blood products; furthermore, they were more likely to develop hypertension and movement disorder after or during weaning. In conclusion, children with RSE who required pentobarbital therapy had a longer hospital stay with more complications.


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  1. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: Frequency, risk factors, and impact on outcome. Arch Neurol 2002;59:205-10.
  2. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 2005;76:534-9.
  3. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: A systematic review. Epilepsia 2002;43:146-53.
  4. Hubert P, Parain D, Vallée L. Management of convulsive status epilepticus in infants and children. Rev Neurol (Paris) 2009;165:390-7.
  5. Morrison G, Gibbons E, Whitehouse WP. High-dose midazolam therapy for refractory status epilepticus in children. Intensive Care Med 2006;32:2070-6.
  6. Abend NS, Huh JW, Helfaer MA, Dlugos DJ. Anticonvulsant medications in the pediatric emergency room and intensive care unit. Pediatr Emerg Care 2008;24:705-18.
  7. Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012;17:3-23.
  8. Gilbert DL, Gartside PS, Glauser TA. Efficacy and mortality in treatment of refractory generalized convulsive status epilepticus in children: A meta-analysis. J Child Neurol 1999;14:602-9.
  9. Kim SJ, Lee DY, Kim JS. Neurologic outcomes of pediatric epileptic patients with pentobarbital coma. Pediatr Neurol 2001;25:217-20.
  10. Holmes GL, Riviello JJ Jr. Midazolam and pentobarbital for refractory status epilepticus. Pediatr Neurol 1999;20:259-64.
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