Parviainen Ilkka, Kälviäinen Reetta, Ruokonen Esko
Department of Anesthesiology and Intensive Care, Kuopio Epilepsy Center, Kuopio University Hospital, Kuopio, Finland.
Neurol Res. 2007 Oct;29(7):667-71. doi: 10.1179/016164107X240044.
To discuss mainly the use of propofol and barbiturates in the anesthesia of refractory status epilepticus (RSE).
Review of literature.
There are no prospective, randomized works comparing the effects of anesthetics in the treatment of RSE. Recently, the use of propofol has increased in the treatment of RSE. Propofol terminates both clinical and electric seizures quickly, but the maintenance of burst-suppression EEG pattern requires repetitive titration of doses. Relapses of seizures have occurred in 19-33% of patients, especially when tapering of dose. The advantages of barbiturates are lower frequency of short-term treatment failures, breakthrough seizures and changes to a different anesthetic agent. On the other hand, prolonged recovery leads to prolonged duration of mechanical ventilation, intensive care and hospital stay.
The use of propofol, barbiturates or midazolam in the anesthesia of RSE can be justified. When using propofol, the duration of high doses should be limited to 48 hours and the risk of propofol infusion syndrome should be kept in mind. High doses of barbiturates terminate effectively seizures but recovery from anesthesia prolongs ventilator treatment and intensive care.
主要探讨丙泊酚和巴比妥类药物在难治性癫痫持续状态（RSE）麻醉中的应用。
文献综述。
尚无前瞻性、随机研究比较不同麻醉药物治疗RSE的效果。近年来，丙泊酚在RSE治疗中的应用有所增加。丙泊酚能迅速终止临床发作和电发作，但维持脑电图爆发抑制模式需要反复滴定剂量。19% - 33%的患者出现癫痫复发，尤其是在剂量递减时。巴比妥类药物的优点是短期治疗失败、突破性发作及更换麻醉药物的频率较低。另一方面，恢复时间延长导致机械通气、重症监护和住院时间延长。
丙泊酚、巴比妥类药物或咪达唑仑用于RSE麻醉是合理的。使用丙泊酚时，高剂量使用时间应限制在48小时以内，并应牢记丙泊酚输注综合征的风险。高剂量巴比妥类药物能有效终止癫痫发作，但麻醉恢复会延长呼吸机治疗和重症监护时间。
