RESUMO
Retrospective analysis was conducted of patients with SRSE who were treated simultaneously with propofol and ketamine. Sixty-seven patients were identified from 2012 to 2015, and outcomes documented were resolution and mortality. The duration of combined ketamine and propofol use ranged from 1 to 28 days (mean - 3.6 days). Infusion rates ranged up to 145 and 175 mcg/kg/min. Vasopressors were used in 53 patients (79%), and were given within the first 5 days of the ICU admission in 48 (91%) patients. The overall SRSE resolution rate was 91%, and the overall mortality including patients with anoxic brain injury was 39%. Of the 13 patients with SRSE as a result of anoxic brain injury, SRSE was controlled in 5 (56%). The primary determinant of mortality was family withdrawing care related to the presence of severe medical/neurological diseases.
Assuntos
Anestésicos Dissociativos/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Ketamina/uso terapêutico , Propofol/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Criança , Cuidados Críticos , Epilepsia Resistente a Medicamentos/mortalidade , Quimioterapia Combinada , Feminino , Humanos , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/mortalidade , Infusões Intravenosas , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Estudos Retrospectivos , Estado Epiléptico/mortalidade , Resultado do Tratamento , Vasoconstritores/uso terapêutico , Adulto JovemRESUMO
A restrospective review of patients treated in the ICU for refractory status epilepticus who had received an initial IV loading dose of lacosamide (LCS) was performed. A total of 142 patients were identified. The first 34 patients received 400mg which by weight-based measurement ranged from 2 to 11 mg/kg. Higher mg/kg dosing had been used subsequently with doses up to 13 mg/kg. No patient required reduction in rate or cessation of infusion. Initiation of pressor agents was not needed during the infusion of the loading dose. Postinfusion LCS blood levels were drawn, and dosing of 10-12 mg/kg and higher resulted in blood levels above 15 µg/ml while doses of 2-6 mg/kg resulted in levels below 10 µg/ml. We conclude that a weight-based loading dose of 10-12 mg/kg at an infusion rate of 0.4 mg/kg/min is safe and will produce levels of 15 µg/ml and higher. This article is part of a Special Issue entitled "Status Epilepticus".