Kofke W A, Young R S, Davis P, Woelfel S K, Gray L, Johnson D, Gelb A, Meeke R, Warner D S, Pearson K S
Department of Anesthesiology, University of Pittsburgh School of Medicine, Pennsylvania 15261.
Anesthesiology. 1989 Nov;71(5):653-9. doi: 10.1097/00000542-198911000-00005.
General anesthesia has been recommended to control convulsive status epilepticus that is refractory to conventional anticonvulsant therapy. Halothane has been the recommended agent, but without experimental justification. Isoflurane, which has no reported organ toxicity and produces electrographic suppression at clinically useful concentrations in normal humans, should be a better volatile anesthetic for this purpose. The efficacy and safety of isoflurane administered to control convulsive status epilepticus were assessed on 11 occasions in nine patients in seven North American hospitals. Isoflurane, administered for 1-55 h, stopped seizures in all patients and was able to be titrated to produce burst-suppression patterns on electroencephalograms. Blood pressure support with iv fluids and/or pressor infusions was required in all of the patients. Seizures resumed upon discontinuation of isoflurane on eight of 11 occasions. Six of the nine patients died. The three survivors sustained cognitive deficits. In one patient urine fluoride concentrations were elevated, although not to nephrotoxic levels. These cases suggest that isoflurane 1) is an effective, rapidly titratable anticonvulsant; 2) does not reverse underlying causes of the refractory seizures; and 3) usually necessitates hemodynamic support with fluids and/or pressors. Isoflurane may be administered for seizures, but only when iv agents in anesthetic doses are ineffective or produce unacceptable side effects.
对于常规抗惊厥治疗无效的惊厥性癫痫持续状态，推荐使用全身麻醉进行控制。氟烷一直是推荐使用的药物，但缺乏实验依据。异氟烷未报告有器官毒性，且在正常人体的临床有效浓度下可产生脑电图抑制，因此作为挥发性麻醉剂用于此目的应该更好。在北美七家医院的九名患者中，对异氟烷用于控制惊厥性癫痫持续状态的疗效和安全性进行了11次评估。异氟烷给药1 - 55小时，所有患者的癫痫发作均停止，且能够进行滴定以在脑电图上产生爆发抑制模式。所有患者均需要静脉输液和/或升压药输注来维持血压。11次中有8次在停用异氟烷后癫痫发作复发。9名患者中有6名死亡。3名幸存者存在认知缺陷。1名患者的尿氟浓度升高，尽管未达到肾毒性水平。这些病例表明，异氟烷1)是一种有效的、可快速滴定的抗惊厥药；2)不能逆转难治性癫痫发作的潜在病因；3)通常需要液体和/或升压药进行血流动力学支持。异氟烷可用于癫痫发作，但仅在麻醉剂量的静脉用药无效或产生不可接受的副作用时使用。
