Super-refractory status epilepticus (SRSE) is a neurological condition with an important morbidity and mortality rate, for which few therapeutic options are available. Inhalation sedation with ...isoflurane is currently a compassionate-use treatment in Spanish intensive care units. Little has been written about its usefulness in the treatment of refractory and super-refractory status epilepticus, but it appears to be a useful and safe therapeutic alternative for this condition.
This article reviews three cases of SRSE treated with isoflurane. The capacity of isoflurane to control seizures was assessed by electroencephalographic monitoring. Other variables assessed were time to seizure control, survival, functional outcome and occurrence of complications secondary to isoflurane. In the three cases reviewed, isoflurane proved to be effective for seizure control in patients affected by SRSE. Seizure control was accomplished quickly and the minimum dose required to obtain a burst-suppression pattern was titrated easily and rapidly. Despite controlling epilepsy, high mortality was observed (66.66%). This is explained by both the mortality of SRSE and the underlying pathologies of the patients who died. The use of isoflurane did not give rise to any complications.
With the results obtained, it is feasible to think that the use of isoflurane is not related to lesions in the central nervous system reported in other articles, and this treatment can be considered effective and safe for the control of SRSE.
Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation ...should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.
La sedación es necesaria en el tratamiento de los pacientes críticos, tanto para aliviar el sufrimiento como para curar a los pacientes con enfermedades que precisan el ingreso en unidades de cuidados intensivos. Esta sedación debe ser la adecuada a las necesidades del paciente en cada momento de su evolución clínica, ni por debajo (infrasedación) ni por encima (sobresedación). Una sedación adecuada influye en la comodidad, la seguridad, la supervivencia, la calidad de vida posterior, la rotación de camas de las unidades de críticos y los costes. La infrasedación se detecta y corrige rápidamente. Sin embargo, la sobresedación es silente y difícil de prevenir sin unas pautas de actuación, una concienciación colectiva y un trabajo en equipo. El proyecto «Sobresedación Zero» del Grupo de Trabajo de Sedación, Analgesia y Delirium de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias pretende ser una herramienta docente, práctica y de concienciación colectiva de comodidad, seguridad y gestión para maximizar el resultado clínico y minimizar los efectos perjudiciales de la sedación excesiva. Se basa en un paquete de medidas que se incluye monitorizar el dolor, la analgesia, la agitación, la sedación, el delirium y el bloqueo neuromuscular, mantener a los pacientes sin dolor, realizar una sedación dinámica según objetivos clínicos, consensuar el protocolo multidisciplinar a seguir y evitar la sedación profunda no indicada clínicamente.
