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2 results

  • Modern Inhalational Anesthetics for Refractory Status Epilepticus

  • Frederick A. Zeiler, Kaitlin J. Zeiler, Jeanne Teitelbaum, Lawrence M. Gillman, Michael West
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 42 / Issue 2 / March 2015
    Published online by Cambridge University Press:
    09 January 2015, pp. 106-115
    • Article
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  • Background: Our goal was to perform a systematic review of the literature on the use of modern inhalational anesthetic agents for refractory status epilepticus and their impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to March 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology by two independent reviewers. Results: Overall, 19 studies were identified, with 16 manuscripts and 3 meeting abstracts. A total of 46 patients were treated. Adult (n=28) and pediatric patients (n=18) displayed 92.9% and 94.4% seizure control with treatment, respectively. Isoflurane was used in the majority of cases. Hypotension was the only complication described. Conclusions: Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence exists to support the use of isoflurane in refractory status epilepticus to obtain burst suppression. Insufficient data exist to comment on the efficacy of desflurane and xenon at this time.

  • 22 - Bariatric outcomes

  • from Section 4 - Post-operative conditions
  • Edited by Adrian Alvarez, Jay B. Brodsky, Stanford University School of Medicine, California, Hendrikus J. M. Lemmens, Stanford University School of Medicine, California, John M. Morton, Stanford University School of Medicine, California
  • Book:
    Morbid Obesity
    Published online:
    04 May 2010
    Print publication:
    11 March 2010, pp -

  • Summary

    This chapter reviews several factors that affect pharmacokinetics (PK) and pharmacodynamics (PD) of anesthetic agents in the obese population and specifies certain dosing scalars. It presents the current knowledge of obesity's effects on the clinical pharmacology of specific drugs that produce or reverse anesthesia. In a PK study in which patients received thiopental to induce anesthesia, absolute total body clearance was significantly larger in the obese than in normal weight patients. In hemodynamically unstable morbid obesity (MO) patients or patients with obesity cardiomyopathy, anesthesic induction with etomidate may be a better choice than either thiopental or propofol. Opioids effectively block somatic and autonomic responses during surgery. Target-controlled infusion (TCI), an anesthetic dosing technique developed during the last decades, allows interactive drug dosing on the basis of common PK-PD models. Sugammadex can reverse profound neuromuscular blockade.