Efficacy of cEEG and hepatic function to diagnose early acute encephalopathy.

BACKGROUND: Early treatment may improve the prognosis of acute encephalopathy (AE). However, methods for early diagnosis have not yet been established. In this paper, we examined methods for the early diagnosis of AE. METHODS: We extracted data on patients with febrile status epilepticus from the electronic medical records in our department between March 2016 and April 2021. Among these, 79 patients who underwent continuous electroencephalography (cEEG) were included in this study. Patients who exhibited psychomotor retardation or abnormal brain magnetic resonance imaging findings were assigned to Group E (n = 20), and the remaining patients were the control group (Group C, n = 59). The following tests were compared retrospectively between these two groups on admission: cEEG, serum hepatic function tests, and blood coagulation tests. RESULTS: The percentage of patients who exhibited high-amplitude slow waves or flat waves on cEEG at the time of admission was statistically significantly higher in Group E than in Group C (p < 0.01). Moreover, the percentage of patients whose high-amplitude slow waves or flat brain waves on admission disappeared within 6 h after an initial episode of convulsion was statistically significantly lower in Group E than in Group C (p < 0.01). Furthermore, all the items in the coagulation and the hepatic function tests were statistically significantly different in Group E from those in Group C (p < 0.05). CONCLUSION: These results showed that cEEG together with hepatic function and coagulation tests may be useful for the differential diagnosis of AE.

Markedly long pause due to sinus arrest during dexmedetomidine use and nasal continuous positive airway pressure in two infants with respiratory syncytial virus infection.

Nasal respiratory support for infants with respiratory distress caused by respiratory syncytial (RS) virus infection sometimes requires appropriate sedation. Dexmedetomidine can be an alternative sedative because of its advantage of less frequent respiratory suppression. We report the cases of twin infants with RS virus infection who showed unreported long pauses (4 and 10 s) due to sinus arrest while receiving dexmedetomidine. After termination of dexmedetomidine administration, the long pause of >2 s was no longer observed in both cases. RS virus infection may inhibit the conduction system and sometimes induce bradyarrhythmia. Cardiac and sinus arrests are reported as complications of dexmedetomidine administration. Thus, because dexmedetomidine administration and RS virus infection may additively or synergistically inhibit the conduction system, the use of dexmedetomidine in infantile RS infection should be carefully considered. If sedation is unavoidable, other drugs should be used first. An evidence-based safe regimen for sedation in infants with RS infection should be established in the near future. .