Convulsive status epilepticus management in adults and children: Report of the Working Group of the Polish Society of Epileptology.

INTRODUCTION: The Working Group was established at the initiative of the General Board of the Polish Society of Epileptology (PSE) to develop an expert position on the treatment of convulsive status epilepticus (SE) in adults and children in Poland. Generalized convulsive SE is the most common form and also represents the greatest threat to life, highlighting the importance of the choice of appropriate therapeutic treatment. AIM OF GUIDELINE: We present the therapeutic options separately for treatment during the early preclinical (>5-30min), established (30-60min), and refractory (>60min) SE phases. This division is based on time and response to AEDs, and indicates a practical approach based on pathophysiological data. RESULTS: Benzodiazepines (BZD) are the first-line drugs. In cases of ineffective first-line treatment and persistence of the seizure, the use of second-line treatment: phenytoin, valproic acid or phenobarbital is required. SE that persists after the administration of benzodiazepines and phenytoin or another second-line AED at appropriate doses is defined as refractory and drug resistant and requires treatment in the intensive care unit (ICU). EEG monitoring is essential during therapy at this stage. Anesthesia is typically continued for an initial period of 24h followed by a slow reversal and is re-established if seizures recur. Anesthesia is usually administered either to the level of the "burst suppression pattern" or to obtain the "EEG suppression" pattern. CONCLUSIONS: Experts agree that close and early cooperation with a neurologist and anesthetist aiming to reduce the risk of pharmacoresistant cases is an extremely important factor in the treatment of patients with SE. This report has educational, practical and organizational aspects, outlining a standard plan for SE management in Poland that will improve therapeutic efficacy.

Single ketamine infusion and neurocognitive performance in bipolar depression.

We estimated neurocognitive performance using the trail making test (TMT) and the Stroop color-word interference test before, and on the 3(rd) day after a single infusion of ketamine, in 18 bipolar depressed patients receiving mood-stabilizing drugs. The performance on all tests significantly improved on the 3(rd) day after ketamine infusion which correlated positively with baseline intensity of neuropsychological impairment and was not associated either with baseline intensity of depression or reduction of depressive symptoms after 3 or 7 days. The results suggest that in such population of patients, single ketamine infusion may improve neuropsychological performance independently of antidepressant effect.

Vitamin B12 level may be related to the efficacy of single ketamine infusion in bipolar depression.

The single infusion of ketamine, an N-methyl-d-aspartic acid (NMDA) glutamate receptor antagonist, exerts a therapeutic effect in both unipolar and bipolar depression. Homocysteine (HCY) acts agonistically on the NMDA receptor, hyperhomocysteinemia is related to depression, and folic acid and vitamin B12 are associated with HCY system. We estimated the serum levels of these substances in 20 bipolar depressed patients before ketamine infusion. 10 patients responded favorably to this procedure, as their score on the Hamilton depression rating scale, compared to baseline, was reduced by more than 50%, after 7 days. The vitamin B12 level was significantly higher in "responders" compared to the remaining patients. No differences between the 2 groups were found with regard to HCY, folic acid levels and such clinical factors as age, duration of illness and duration of current episode. These preliminary data suggest that the vitamin B12 level may be connected with the efficacy of ketamine infusion in bipolar depression.

[Patient satisfaction with anesthesia as a measure of quality of anesthesia care]. / Satysfakcja pacjenta znieczulanego pomiarem jakosci opieki anestezjologicznej.

Patient satisfaction with anaesthesia is very important as a expectancy satisfaction in perioperative care. It is simultaneously patient opinion about the anaesthetic care prior to and during anaesthesia, and shortly after the operation. The aim of the research was to evaluate the patient satisfaction and to determine the factors connected with satisfaction in the perioperative period Out of a total of 250 patients, 155 women (62%) and 95 men (48%) underwent general and local anaesthesia due to the operations. They answer 55 questions on the third day after the operation. At the same time anaesthesiologists and nurses evaluate the quality of theirselves anaesthesia. In the opinion of anaesthetic team the quality of anaesthesia was very good--51.6%, good--46.8% and adequate only 2.6%. Positive opinion about the quality of anaesthesia expressed 87% of patients, negative only 0.5% and 12.5% have no opinion. The very good atmosphere was in Preanaesthetic Evaluation Clinic and during the admission to the operating room. The factors decreased patient satisfaction immediately after the operation were breathing difficulties, vomiting, nausea, feeling coldness and pain. The main factors evaluating the quality of anaesthetic care and patient satisfaction are specific information, proper premedication and feeling safety in the operating room. On the other hand the discomfort and insufficient analgesia decreased patient satisfaction with anaesthesia.