Seizures propofol

Pentobarbital is commonly loaded at a dose of 10 to 15 mg/kg over 1 to 2 hours, followed by a continuous infusion of 0.5 to 4 mg/kg per hour. Therapy can be tapered off after 12 to 24 hours of seizure control as evident on the EEG.35 One metaanalysis reported a lower incidence of treatment failure with pentobarbital (3%) when compared to midazolam (21%) or propofol (20%), although the risk of hypotension requiring vasopressor therapy was higher when pentobarbital was used.36 This relative efficacy for pentobarbital must be considered... 

A metaanalysis showed that among patients refractory to GCSE, pentobarbital had a 92% response rate, compared to midazolam (80%) and propofol (73%). Breakthrough seizures were least common with pentobarbital (12%, compared with propofol [15%] and midazolam [51%]). Hypotension was more common with midazolam and propofol. 

Refractory status epilepticus that has failed to respond to one of these treatments, and has continued for more than 20-30 min, requires urgent action. The accepted strategy is to paralyze and ventilate the patient and administer an antiepileptic drug in sufficient dosage to suppress EEG evidence of seizure activity. The barbiturate anaesthetic thiopental (thiopentone), the benzodiazepine midazolam, and the anaesthetic propofol have all been used. What little comparative evidence there is remains inconclusive. Such treatment can only be carried out with facilities for artificial ventilation and intensive care, and effects can only be monitored by EEG recording. 

Seizures induced by local anesthetics are usually treated with intravenous anesthetic drugs (eg, thiopental 1-2 mg/kg, propofol 0.5-1 mg/kg, midazolam 0.03-0.06 mg/kg). The muscular manifestations of a seizure can be blocked using a short-acting neuromuscular relaxant drug (eg, succinylcholine, 0.25-0.5 mg/kg IV). It should be emphasized that succinylcholine does not alter the CNS manifestations of local anesthetic-induced seizure activity. Rapid tracheal intubation can prevent pulmonary aspiration of gastric contents and facilitate hyperventilation. 

A 10-year-old child had status epilepticus controlled with a combination of valproate, oxcarbazepine, and 48 hours of propofol infusion in a dose of 5.5 mg/kg/ hour. After weaning from propofol, a classic ketogenic diet was instituted in an attempt to provide long-term control of the seizures. A day later status epilepticus recurred and propofol was restarted at a rate of 6-9 mg/ kg/hour to suppress seizure activity (the diet, valproate, and oxcarbazepine were also continued). Shortly thereafter, he developed the classical constellation of malignant ventricular arrhythmias, hyperlipidemia, rhabdomyolysis, lactic acidosis, and biventricular cardiac failure. He did not survive. 

Benzodiazepines can be used to control agitation. Avoid phenothiazines due to possible hypotension. Animals may need to be heavily sedated so they do not injure themselves or others. Control seizures with a benzodiazepine, pheno-barbital, or propofol. Rhabdomyolysis can occur if agitation or seizures are not controlled. 

Methohexitone is a barbiturate similar to thiopental but its terminal t) is considerably shorter. Since the introduction of propofol, its use is almost entirely confined to inducing anaesthesia for electrocontro-vulsive therapy (ECT). Propofol shortens seizure duration and may reduce the efficacy of ECT. 

When etomidate was given to 12 patients who had seizures of short duration during electroconvulsive therapy conducted previously under propofol anesthesia, mean seizure duration was significantly increased with etomidate anesthesia (12). However, there is no evidence that this observation is associated with an improved psychiatric outcome. 

Stadtland C, Erfurth A, Ruta U, Michael N. A switch from propofol to etomidate during an ECT course increases EEG and motor seizure duration. 1 ECT 2002 18(l) 22-5. 

Lee VC, Moscicki JC, DiFazio CA. Propofol sedation produces dose-dependent suppression of lidocaine-induced seizures in rats. Anesth Analg 1998 86(3) 652-7. 

A 74-year-old man was to receive a combined sciatic nerve and psoas compartment block for a total hip arthroplasty the classic Labat s approach was used and 30 ml of 0.75% ropivacaine was injected over 1.5 minutes, after which he suddenly became unresponsive and developed tonic-clonic movements. Propofol was administered and the seizure resolved, but he developed sinus bradycardia with progressive lengthening of the QRS interval, which converted to nodal bradycardia. A ventricular escape rhythm at 20/minute with T wave inversion was treated with ephedrine 10 mg and adrenahne 0.1 mg, resulting in supraventricular tachycardia with transient atrial fibrillation. 

Myoclonus and opisthotonos, especially in children (38), and choreoathetosis (39) have been attributed to propofol. However, in experimental studies propofol has been shown to be effective against drug-induced seizures (40,41). It has been suggested that propofol inhibits efferent inhibitory neurons in the midbrain and reticular activating system, producing movements that originate subcortically and in the spinal cord (42). 

A generalized tonic-clonic seizure has been attributed to propofol in a patient with tonic-clonic seizures after surgery for subarachnoid hemorrhage (46). 

A 51-year-old woman with a past medical history of a seizure disorder, schizophrenia, and asthma, who had been admitted with pneumonia, was sedated using a propofol infusion to assist mechanical ventilation (65). Over 7 days she received a total of 26.5 g of propofol at a maximum rate of 0.2 mg/kg/minute. When pancreatitis, which was associated with hypertriglyceridemia, was diagnosed, the propofol infusion was stopped. In addition to raised amylase activity, serum triglyceride concentrations peaked at 17 mmol/1 and lipase activity at 564 U/1. She recovered over the next 7 days. On day 17 she underwent tracheostomy revision, during which... 

Excitation, including generalized tonic-clonic seizures, has been observed on withdrawal of a propofol infusion in intensive care (79). 

Hasan MM, Hasan ZA, al-Hader AF, Takrouri MS. The anticonvulsant effects of propofol, diazepam, and thiopental, against picrotoxin-induced seizure in the rat. Middle East J Anesthesiol 1993 12(2) 113-21. 

Heavner JE, Arthur J, Zou J, McDaniel K, Tyman-Szram B, Rosenberg PH. Comparison of propofol with thiopentone for treatment of bupivacaine-induced seizures in rats. Br J Anaesth 1993 71(5) 715-19. 

Iwasaki F, Mimura M, Yamazaki Y, Hazama K, Sato Y, Namiki A. [Generalized tonic-clonic seizure induced by propofol in a patient with epilepsy.] Masui 2001 50(2) 168-70. 

Heldmann E, Hoit D E, Brockman D J et al 1999 Use of propofol to manage seizure activity after surgical treatment of portosystemic shunts. Journal of Small Animal Practice 40 590-594... 

Nervous System The CNS effects of propofol are similar to those of barbiturates, but, unlike thiopental, propofol is not a proven acute intervention for seizures. 

Anesthetic induction agents These (e.g. methohexital, propofol, thiopental sodium) rapidly induce hypnosis, without significantly shortening seizure activity or causing hemodynamic instability, and thus allow for rapid emergence from anesthesia. 

Status epilepticus i.s defined as continuou.s seizure.s lasting at least 30 minute.s or a state in which fits follow each other without consciousness being fully regained. Urgent treatnient with intravenous agents (bottom left) is neccs.sary to Stop the fits, which, if unchecked, result 111 exhaustion and cerebral damage. Lorazepam or diazepam is used initially followed hy phenyloin if necessary, [f the fits are not controlled, the patient is anaesthetized with propofol or thiopental. 

B. Convulsions. Note If convulsions persist after Initial doses of benzodiazepines, consider alternate anticonvulsant dmgs such as phenobarbital (see p 486), phenytoin (p 488), pentobarbital (p 485), or propofol (p 494). Also, see treatment of seizures (p 22). 

C. Anesthetic doses may be associated with myoclonus, posturing, and seizurelike movement phenomena (jerking, thrashing). Seizures have been noted when weaning from propofol. Allergic reactions to metabisulfite are possible. Bacterial infections have also been noted. 

Severe seizures occurred during induction of anaesthesia with propofol in a patient taking baclofen. 

Manikandan S, Sinha PK, Neema PK, Ratiiod RC. Severe seizures during propofol induction... 

The respiratoiy depressant effects of ketamine and morphine may be additive. The dose requirements of desflurane, etomidate, propofol and thiopental may be lower after opioid use. Opisthotonos or grand mal seizures have rarely been associated with the use of propofol with alfentanil and/or fentanyl. The effects of in-halational anaesthetics may be enhanced by opioid analgesics. 

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