Sevoflurane for the treatment of refractory status epilepticus in the critical care unit

Abstract

SummaryA 50‐year‐old woman with liver failure was admitted to critical care for refractory status epilepticus (RSE). Following tracheal intubation, sevoflurane was administered via the MIRUSTM system (Pall Medical, Dreieich, Germany). Following incremental increases in minimum alveolar concentration (MAC) from 0.3 to 1.0, there was a suppression of motor activity and continuous electroencephalogram (EEG) monitoring revealed suppression of seizure activity. Sevoflurane was progressively reduced to 0.3 MAC and the EEG recovered. Forty‐eight hours later, sevoflurane was discontinued followed by extubation. The patient was discharged from hospital a further 48 hours later. We argue that volatile anaesthetics can be titrated to a continuously monitored EEG in cases of RSE. Moreover, there now exists technology to safely and accurately administer volatile anaesthetics, which may have certain advantages over intravenous agents, in the critical care environment.