Sevoflurane for the treatment of refractory status epilepticus in the critical care unit

Sevoflurane for the treatment of refractory status epilepticus in the critical care unit

Published: 19 Jun 2018

© Anaesthesia Cases / 2018-0090 / ISSN 2396-8397

Authors

Assistant Prof. Stefano Romagnoli [1]
Dr Gianluca Villa [2]
Dr Zaccaria Ricci [3]
Prof Fabio Marra [4]
Dr Aldo Amantini [5]
  • [1] Consultant, Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • [2] Consultant, Anesthesia and Critical Care , Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
  • [3] Consultant, Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  • [4] University Professor, Dipartimento di Medicina Sperimentale e Clinica, Medicina Interna ed Epatologia, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
  • [5] Consultant, SODc Neurosiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso - Unità di Riabilitazione Neurologic, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

Summary

A 50-year-old woman with liver failure was admitted to critical care for refractory status epilepticus (RSE). Following tracheal intubation, sevoflurane was administered via the MIRUS™ system (Pall Medical, Dreieich, Germany). Following incremental increases in minimum alveolar concentration (MAC) from 0.3 to 1.0, there was a suppression of motor activity and continuous electroencephalogram (EEG) monitoring revealed suppression of seizure activity. Sevoflurane was progressively reduced to 0.3 MAC and the EEG recovered. Forty-eight hours later, sevoflurane was discontinued followed by extubation. The patient was discharged from hospital a further 48 hours later. We argue that volatile anaesthetics can be titrated to a continuously monitored EEG in cases of RSE. Moreover, there now exists technology to safely and accurately administer volatile anaesthetics, which may have certain advantages over intravenous agents, in the critical care environment.

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