Treatment of Refractory Status Epilepticus with Propofol: Clinical and Pharmacokinetic Findings

Authors

  • Mark M. Stecker,

    Corresponding author
    1. Departments of Neurology, Hospital of the University of Pennsylvania, U.S.A.
      Address correspondence and reprint requests to Dr. M. M. Stecker at Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, U.S.A.
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  • Thomas H. Kramer,

    1. Departments of Anesthesia, Hospital of the University of Pennsylvania, U.S.A.
    2. Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, Philadelphia, Pennsylvania, U.S.A.
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  • Eric C. Raps,

    1. Departments of Neurology, Hospital of the University of Pennsylvania, U.S.A.
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  • Rosemary O'Meeghan,

    1. Departments of Anesthesia, Hospital of the University of Pennsylvania, U.S.A.
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  • Eugene Dulaney,

    1. Departments of Neurology, Hospital of the University of Pennsylvania, U.S.A.
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  • Debra J. Skaar

    1. Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, Philadelphia, Pennsylvania, U.S.A.
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Address correspondence and reprint requests to Dr. M. M. Stecker at Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, U.S.A.

Abstract

Summary: Purpose: We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels.

Methods: Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol.

Results: Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) than with high-dose barbiturate therapy (82%). The time from initiation of high-dose barbiturate therapy to attainment of control of RSE was longer (123 min) than the time to attainment of seizure control in the group receiving propofol (2.6 min, p = 0.002). Plasma concentrations of propofol associated with control of SE were 14 μM ± 4 (2.5 μg/ml). Recurrent seizures were common when propofol infusions were suddenly discontinued but not when the infusions were gradually tapered.

Conclusions: If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.

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