Burcu ALTUNRENDE, Kazım KARAASLAN, Nebahat GÜLCÜ, Esra GÜMÜŞ

Dirençli jeneralize status epileptikusun propofol ile tedavisi

Status epileptikus, jeneralize, konvülzif nöbetlerin sürekli olarak 5 dakika veya daha uzun sürmesi ya da bilinçte düzelme olmaksızın 2 veya daha fazla sayıda nöbet geçirilmesi şeklinde tanımlanmaktadır. Morbidite ve mortalitesi yüksek acil tıbbi durumlardan biridir. Dirençli status epileptikus ise konvansiyonel antiepileptik ilaç tedavisine rağmen, iki saatten fazla süren nöbetlerin olması veya saatte iki veya daha fazla nöbetin olduğu ve nöbet aralarında bilincin bazal değerlere dönmediği tablo olarak tanımlanmaktadır. Bu makalede propofol infüzyonu ile kontrol altına alınabilen dirençli bir status epileptikus olgusu sunulmuş ve literatür eşliğinde tartışılmıştır.

Treatment of refractory generalized status epilepticus with propofol

Status epilepticus, a major medical emergency associated with significant morbidity and mortality, is defined as a continuous, generalized, convulsive seizure lasting more than 5 minutes, or two or more seizures during which the patient does not return to baseline consciousness. Refractory status epilepticus is defined as seizures lasting more than 2 hours, or seizures recurring at a rate of two or more episodes per hour without recovery to baseline between seizures, despite treatment with conventional antiepileptic drugs. A case of refractory status epilepticus controlled by propofol infusion is presented in this report, and discussed in the light of literature.

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1. Prasad A. Worrall BB, Bertram EH, et al. Propofol and Midazolam in the treatment of refractory status epilepticus. Epilepsia 42:380-386. 2001
2. Lowenstein DH, Alledredge BK. Status epilepticus. N Engl J Med 338:970-976. 1998
3. Bleck TP. Management approches to prolonged seizures and status epilepticus. Epilepsia 40:59-63. 1999
4. Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia 40(1):120-2. 1999
5. Treiman DM, Meyers PD, Walton NY. A comparison of four treatments for generalized convulsive status epilepticus: Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339:792-798. 1998
6. Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 30;345(9): 631–7. 2001
7. Marik PE and Varon J. The Management of Status Epilepticus. CHEST 126:582- 591. 2004
8. Mayer SA, Claassen J, Lokin J et al. Refractory status epilepticus: frequency, risk factors, and impact on outcome, Arch Neurol 59:205-210. 2002
9. Classen J, Hirch LJ, Emerson RG, et al. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 43:146-153. 2002.
10. Stecker MM, Kramer TH, Raps EC, et al. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia 39:18-26. 1998
11. Smith I, White PF, Nathanson M, et al. Propofol: an update on its clinical use. Anesthesiology 81:1005-1043. 1994
12. Hara M, Kai Y, İkemoto Y. Propofol activates GABAA receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat. Anesthesiology 79:781-788. 1993
13. Green TR, Bennett SR, Nelson VM. Specificitynad properties of propofol as an antioxidant free radical scavenger. Toxicol Appl pharmacol 129:163-169. 1994
14. Hantson P, Van Brandt N, Verbeeck R, et al. Propofol for refractory status epilepticus. Intensive Care Med 20:611-613. 1994
15. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 29:1417-1425. 2003
16. Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 305:613-616. 1992
17. Aitkenhead AR, Willatts SM, Park GR, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet 2:704-709. 1989
18. Carrasco G, Mollina R, Costa J, Soler JM, Cabre L. Propofol vs Midazolam in short -, medium-, long-term sedation for critically ill patients. Chest 103:557-564. 1993
19. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 161:1530–6. 2000
20. Henry TR, Drury I, Brunberg JA, Pennell PB, McKeever PE, Beydoun A. Focal cerebral magnetic resonance changes associated with partial status epilepticus. Epilepsia 35:35-41. 1994.

Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1999
Yayıncı: Düzce Üniversitesi Tıp Fakültesi

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