Summary
When conventional treatment for status epilepticus fails, general anaesthesia is recommended. We present our experience with isoflurane, an inhalational anaesthetic, in the management of four patients with status epilepticus which occurred soon after surgery for motor area lesion. The seizures were controlled with relatively small concentrations of isoflurane. Hypotension, the only adverse effect of isoflurane, was managed easily with the use of dopamine in physiological saline. Although status epilepticus occurring soon after surgery is transient, it carries a risk of persistent brain damage if active treatment is not instituted promptly. Isoflurane general anaesthesia may be recommended to control it in the intensive neurosurgical care.
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References
Aminoff MJ, Simon RP (1980) Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med 69: 657–666
Baden JM, Rice SA (1986) Metabolism and toxicity of inhaled anesthetics. In: Miller RD (eds) Anesthesia. Churchill Livingstone, New York, pp 701–744
Delgado-Escueta AV, Wasterlain C, Trieman DM, Porter RJ (1982) Management of status epilepticus. N Engl J Med 306: 1337–1340
Eger EI, Stevens WC, Cromwell TH (1971) The electroencephalogram in mean anesthetized with Forane. Anesthesiology 35: 504–508
Egar EI (1981) Isoflurane: a review. Anesthesiology 55: 559–576
Gallagher TJ, Galindo A, Richey ET (1978) Inhibition of seizure activity during enflurane anesthesia. Anesth Analg 57: 130–132
Ito BM, Sato S, Kufta CV, Tran D (1987) Effect of isoflurane and enflurane on the electrocorticogram (ECOG) of epileptic patients (abstract). Neurology [Suppl] 37: 91
Jennett WB (1969) Early traumatic epilepsy. Lancet 1: 1023–1026
Kassell NF, Hitchon PW, Gerk MK, Sokoll MD, Hill TR (1980) Alterations in cerebral blood flow, oxygen metabolism, and electrical activity produced by high dose sodium thiopental. Neurosurgery 7: 598–603
Kofke WA, Snider MT, Young PSK, Ramer JC (1985) Prolonged low flow isoflurane anesthesia for status epilepticus. Anesthesiology 62: 653–656
Kofke WA, Young RS, Davis P, Woelfel SK, Gray L, Johnson D, Gelb A, Meeke R, Warner DS, Pearson KS, Gibson JR, Koncelik J, Wessel HB (1989) Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology 71: 653–659
Lowenstein DH, Aminoff MJ, Simon RP (1988) Barbiturate anesthesia in the treatment of status epilepticus. Neurology 38: 395–400
Lowe HJ, Ernst EA (1981) The quantitative practice of anesthesia. Williams and Wilkins, Baltimore/London
Marshall BE, Wollman H (1980) General anesthetics. In: Gilman AG, Gilman LS (eds) The pharmacological basis of therapeutics, 5th Ed. Macmillan, New York, pp 276–299
Meekre RI, Soifer BE, Gelf AW (1989) Isoflurane for the management of status epilepticus. DICP 23: 579–581
Meldrum BS, Brierly JB (1973) Prolonged epileptic seizures in primates: ischemic cell change and its relation to ictal physiological events. Arch Neurol 28: 10–17
Michenfelder JD (1974) The interdependency of cerebral function and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 41: 231–236
Newberg LA, Milde JH, Michenfelder JD (1983) The cerebral metabolic effects of isoflurane at and above concentration which suppress cortical electrical activity. Anesthesiology 59: 23–29
Opitz A, Oberwetter D (1979) Enflurane or halothane anesthesia for patients with cerebral convulsive disorders? Acta Anesthesiol Scand [Suppl] 71: 43–47
Opitz A, Marschall M, Degan R, Koch D (1983) General anesthesia in patients with epilepsy and status epilepticus. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ (eds) Mechanism of brain damage and treatment. Raven Press, New York, pp 531–535
Orlowski JP, Erenberg G, Hans L (1984) Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 12: 362–372
Oshima E, Urabe N, Shingu K, Mori K (1985) Anticonvulsant actions of enflurane on epilepsy models in cats. Anesthesiology 63: 29–40
Pagni CA (1990) Posttraumatic epilepsy. Incidence and Prophylaxis. Acta Neurochir (Wien) [Suppl] 50: 28–47
Pauca AL, Dripps RD (1973) Clinical experience with isoflurane (Forane). Br J Anaesth 45: 697–703
Rashkin MC, Youngs C, Penovich P (1987) Pentobarbital treatment of refractory status epilepticus. Neurology 37: 500–503
Rosen I, Soederberg M (1975) Electroencephalographic activity in children under enflurane anesthesia. Acta Anesthesiol Scand 19: 361–369
Rougier A (1990) The epileptic focus versus the pathological focus. Acta Neurochir (Wien) [Suppl] 50: 1–5
Schwarcz R, Whetsell WO Jr, Mangano RM (1983) Quinolinic acid: an endogenous metabolite that produces axon-sparing lesions in rat brain. Science 219: 316–318
Steen PA, Michenfelder JD (1979) Neurotoxicity of anesthetics. Anesthesiology 50: 437–453
Triner L, Vulliemoz Y, Verosky M, Woo S-Y (1980) Action of volatile anesthetics in brain. In: Fink BR (ed) Molecular Mechanisms of Anesthesia, Vol 2. Raven Press, New York, pp 229–239
Welty TE, Kreal RL (1985) Pentobarbital coma for treating intractable seizures in a neonate. Clin Pharm 4: 330–32
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Sakaki, T., Abe, K., Hoshida, T. et al. Isoflurane in the management of status epilepticus after surgery for lesion around the motor area. Acta neurochir 116, 38–43 (1992). https://doi.org/10.1007/BF01541251
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DOI: https://doi.org/10.1007/BF01541251