The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

PROLONGED UTILIZATION OF ISOFLURANE ANESTHESIA IN A CASE OF REFRACTORY PEDIATRIC STATUS EPILEPTICUS IN THE PEDIATRIC INTENSIVE CARE UNIT

Steven Sittig1, Sheri Crowe1



Introduction: The criteria for Refractory Pediatric Status Epilepticus (RSE) are met when a patient has persistent seizure activity despite being loaded with at least two antiepileptic drugs. Persistent seizure activity can be described as: 1) greater than 30 minutes of continuous seizure activity or 2) two or more sequential seizures without recovery of full consciousness between. RSE is often managed by placing the patient in a barbiturate induced coma. There are case reports in the literature of using an inhaled anesthetic agent such as isoflurane for RSE refractory to barbiturates. We report our experience using isoflurane for a total of 88 days in a 5 yr. old female with RSE.

Case Summary:
A 5 year old previously healthy female presented with new onset seizures in the setting of a febrile illness. Her seizures persisted despite being loaded with three anticonvulsants. The bursts of seizures persisted and the patient required intubation for airway protection. A continuous Pentobarbital infusion was instituted as the seizure frequency continued to progress despite aggressive anticonvulsant therapy. Due to the unresponsive nature of her seizures bursts, Isoflurane anesthesia was then instituted. The anesthetic was delivered with an FDA approved Servo 900C anesthesia system (Maquet Bridgewater, NJ). 24/7 anesthesia department support for this system was not available for the PICU. Therefore the Isoflurane delivery system was monitored and maintained by the pediatric ICU respiratory therapy staff. The system was checked a minimum of every four hours and the vaporizer was filled as needed by the RT staff.

Adjustments to the MAC were completed by the anesthesia service when requested.

Discussion:
Refractory Status Epilepticus is a medical emergency with significant morbidity and mortality. The addition of inhaled Isoflurane can be an important adjunct in the treatment of RSE. Our experience demonstrates that prolonged isoflurane anesthesia can be safely delivered in an ICU setting. Requirements for monitoring/administration include trained pediatric respiratory therapists cognizant of the anesthetic delivery/ventilator connections and regular environmental testing of ambient isoflurane levels.

Conclusions: