Thiamylal anaesthetic therapy for febrile refractory status epilepticus in children
Thiamylal anaesthetic therapy for febrile refractory status epilepticus in children
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硫淀粉醛麻醉治疗儿童发热难治性癫痫持续状态
DOI：
10.1016/j.seizure.2020.03.012
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Nagase H
中科院分区：
文献类型：
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作者：
Ishida Y;Nishiyama M;Yamaguchi H;Tomioka K;Tanaka T;Takeda H;Tokumoto S;Toyoshima D;Maruyama A;Seino Y;Aoki K;Nozu K;Nishimura N;Kurosawa H;Iijima K;Nagase H
目的探讨应用硫胺醛麻醉巴比妥类药物治疗儿童发热难治性癫痫持续状态（fRSE）的疗效。方法：回顾性分析2012年4月至2016年3月在日本一家儿科医院前瞻性收集的经硫氨酰胺麻醉治疗的fRSE病例数据库。样本包括23名患有fRSE的儿童（中位年龄23个月），他们在静脉注射苯二氮卓类和非苯二氮卓类抗惊厥药后持续抽搐发作时间超过60分钟，接受硫氨酰胺麻醉治疗。干预包括以方案为基础的硫氨甲酰麻醉治疗和大剂量给药。我们通过脑电图、癫痫复发、死亡、神经系统后遗症和并发症测量了达到爆发抑制模式（BSP）所需的剂量和时间。结果除1例患者外，其余患者均达到BSP。达到BSP的中位剂量为27.5 mg/kg，从给药到达到BSP的中位时间为109.5 min。1例立即治疗失败，1例戒断性癫痫发作，但无突破性癫痫发作。治疗期间无死亡发生，4例（17%）出现神经系统后遗症。所有病例均给予血管加压药。其他并发症包括11例肺炎和1例小肠结肠炎。结论本研究揭示了儿童硫柳醛注射剂达到BSP所需的时间和剂量。我们的研究结果表明，与不给药相比，给药后达到BSP所需的时间明显更短，在小儿fRSE中很少引起癫痫复发，并且引起血流动力学功能障碍和感染的发生率与不给药时相同。
PurposeTo evaluate barbiturate anaesthetic therapy using thiamylal for febrile refractory status epilepticus (fRSE) in children.MethodsThis was a review of a prospectively-collected database between April 2012–March 2016 for fRSE cases treated with thiamylal anaesthetic therapy in a single paediatric hospital in Japan. The sample comprised 23 children (median age, 23 months) with fRSE that underwent thiamylal anaesthetic therapy for convulsive seizures lasting longer than 60 min, sustained after intravenous administration of benzodiazepine and non-benzodiazepine anticonvulsants. The intervention comprised protocol-based thiamylal anaesthetic therapy with bolus administration. We measured the dose and time required to achieve the burst suppression pattern (BSP) on electroencephalography, seizure recurrence, death, neurological sequelae, and complications.ResultsAll patients except one reached the BSP. The thiamylal median dose until reaching the BSP was 27.5 mg/kg, and the median time from thiamylal administration to reaching the BSP was 109.5 min. There was one case ofimmediate treatment failureand one ofwithdrawal seizure, but nobreakthrough seizure.No deaths occurred during treatment, and neurological sequelae occurred in four cases (17%). Vasopressors were administered in all cases. Other complications included 11 cases of pneumonia and one of enterocolitis.ConclusionWe revealed the time and dose required to reach the BSP with thiamylal anaesthetic therapy using bolus administration in children. Our results suggested that reaching the BSP with bolus administration requires markedly less time than without bolus administration, rarely causes seizure recurrence in paediatric fRSE, and causes haemodynamic dysfunction and infections as often as observed without bolus administration.