Abstracts

Rationale: For treating refractory status epilepticus (RSE), general anesthetics-induced coma therapy has been recommended. However, the role of electroencephalographic (EEG) burst suppression (BS) on outcome remains unclear. This study investigated the correlation of intravenous anesthetics induced BS and prognosis of RSE.Methods: This study was a retrospective analysis of all consecutive adult patients who received intravenous anesthetics treatment for RSE at the Seoul National University Hospital from January 2006to June 2011. We screened the computerized database to indentified the cases and reviews the electronic medical record and the computerized electroencephalographic(EEG) report system for variablesResults: Of total 111 episode of SE, 22 cases were enrolled. The mean age was 52.6 21.4 years (range of 18 86 years) and of these, 12 (54.5%) were women. Of 22 RSE cases,18 were convulsive generalized status epilepticus (81.4%). Sixteen cases (72.7%) were classified as having acute symptomatic etiology, including 3 cases of anoxic encephalopathy; others with remote symptomatic etiology. Only two cases (9.1%) had a favorable STESS score (0-2) at admission. All cases received midazolam (MDZ) as a initial intravenous anesthetics for RSE treatment; three cases (13.6%) received MDZ and propofol (PPF); and one case (4.5%) received MDZ and pentobarbital. The mortality and poor outcome at discharge were 13.6% (n=3) and 54.5% (n=12), respectively. Achievement of induced burst suppression was not correlated with mortality and poor outcome. And, induced BS or isoelectric EEG were also associated with prolonged hospital stay in subgroup analysis excluding anoxic encephalopathy. Respiratory, cardiac and infectious complications occurred in 21 cases (95.5%), 8 cases (36.4%), and 12 cases (54.5%), respectively. There was a non-significant trend toward more cardiac and infectious complication at failing seizure control with anesthetics. (5 of 7, 71.4% in uncontrolled seizure versus 3 of 15, 20% in controlled seizure, P= 0.052; and 6 of 7, 85.7% versus 6 of 15, 40%, P= 0.074, respectively)Conclusions: Our results suggested that the burst-suppression for treating RSE did not associated with mortality and poor outcome at discharge; and moreover it could be associated with prolonged length of stay in hospital.