Refractory status epilepticus (RSE) is defined by persistent
seizures, resistant to first-line (benzodiazepines)
and second-line (“classic” anticonvulsant therapy, suchas valproate, phenytoin/fosphenytoin or levetiracetam),
usually requiring general anesthesia and continuous
electroencephalogram (EEG) monitoring . This is of
particular importance since up to 43 % of patients with
status epileptics will progress to RSE. Rossetti and Bleck
recently proposed an update on the management of status
epilepticus .
This article reviews the recent literature on convulsive RSE in adults, aiming to summarize
advantages/disadvantages and comparative studies of
“standard” intravenous anesthetics (propofol, midazolam,
barbiturates) and describe the emerging use of the alternative
anesthetic agent, ketamine. An algorithm is p[roposed for the management of RSE in the ICU.
Note the option and role of ketamine.
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