However, different anesthetic agents have been used in the groups being evaluated. There are limited studies with conflicting results reporting on the effect of anesthetic drug-induced BS and its related clinical outcomes. A recent guideline has recommended the initiation of an anesthetic infusion with cEEG to suppress seizure activity or burst suppression. However, these results were biased because of a lack of continuous electroencephalogram (cEEG) in the pentobarbital group and in those patients commonly experiencing subtle or non-convulsive seizures. Ī previous systematic review found that patients receiving pentobarbital had a lower frequency of breakthrough seizure as well as a lower rate of treatment failure. Midazolam has been shown to have a wide margin of safety and broad /therapeutic index, and be easy to use. The major concerns of an anesthetic drug infusion are prolonged duration of mechanical ventilation, immobilization, hypotension, cardiac complications as well as propofol-infusion syndrome. Available anesthetic drugs for continuous infusion include midazolam, propofol and pentobarbital. However, current guidelines recommend treatment with a continuous infusion of an anesthetic drug. The best management of refractory status epilepticus remains unclear. Also, RSE patients experience functional impairment at discharge and long-term morbidity. This condition is associated with progressively increasing intrahospital mortality ranging between 19 and 67% depending on the study. Refractory status epilepticus develops in approximately 30–40% of patients with status epilepticus. Refractory status epilepticus (RSE) is defined as status epilepticus that cannot be controlled with an adequate dose of first-line and second-line antiepileptic drugs. Additionally, it was not associated with an increased rate of intra-hospital complications or long-term outcomes. This study provides evidence that BS is safe and associated with less breakthrough seizures.
There was weak evidence of an association between BS and increased withdrawal seizure, but no association between BS and intra-hospital complications, mortality or functional outcomes was observed. The incidence risk ratio was 0.30 (95% confidence interval = 0.13–0.74). Breakthrough seizure was less often seen in the burst suppression group than in the non-burst suppression group. Burst suppression was achieved in 26 patients (51%) 25 patients (49%) had non-burst suppression on their cEEG. We included 51 non-anoxic encephalopathy, refractory status epilepticus patients. Modules were based on a pre-compiled directed acyclic graph (DAG). Methodsīased on a prospective database of patients who had been diagnosed with status epilepticus via cEEG, multivariate Poisson regression modules were used to estimate the effect of midazolam-induced BS on breakthrough seizure, withdrawal seizure, intra-hospital complications, functional outcome at 3 months, and mortality. This study aimed to analyze the effects of midazolam-induced BS on the occurrence outcomes in refractory status epilepticus patients. However, previous studies have reported conflicting results, possibly owing to the inclusion of various anesthetic agents, not all patients undergoing continuous electroencephalography (cEEG), and the inclusion of anoxic encephalopathy. The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS).