Prolonged High-Dose Isoflurane for Refractory Status Epilepticus: Is It Safe?

被引：43

作者：

Fugate, Jennifer E. ^{[1
]}

Burns, Joseph D. ^{[1
]}

Wijdicks, Eelco F. M. ^{[1
]}

Warner, David O. ^{[2
]}

Jankowski, Christopher J. ^{[2
]}

Rabinstein, Alejandro A. ^{[1
]}

机构：

[1] Mayo Clin, Dept Neurol, Rochester, MN 55905 USA

[2] Mayo Clin, Dept Anesthesiol, Rochester, MN 55905 USA

来源：

ANESTHESIA AND ANALGESIA | 2010年 / 111卷 / 06期

关键词：

VOLATILE ANESTHETICS; EARLY EXPOSURE; APOPTOSIS; BRAIN; YOUNG;

D O I：

10.1213/ANE.0b013e3181f6da34

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Isoflurane is an alternative treatment for refractory status epilepticus. Little is known regarding human toxicities caused by isoflurane. We present 2 patients with prolonged refractory status epilepticus treated with high concentrations of isoflurane who developed signal abnormalities on magnetic resonance imaging. Patient 1 was treated with isoflurane for 85 days with 1975.2% concentration-hours. Patient 2 was treated with isoflurane for 34 days with 1382.4% concentration-hours. Serial brain magnetic resonance images in both showed progressive T2 signal hyperintensity involving thalamus and cerebellum, which improved after discontinuation of isoflurane. These cases suggest that isoflurane may be neurotoxic when used in high doses for long time periods.

引用

收藏

页码：1520 / 1524

页数：5

相关论文

共 24 条

[1] Prolonged refractory status epilepticus with early and persistent restricted hippocampal signal MRI abnormality [J].

Chevret, Laurent ;

Husson, Beatrice ;

Nguefack, Seraphin ;

Nehlig, Astrid ;

Bouilleret, Viviane .

JOURNAL OF NEUROLOGY, 2008, 255 (01) :112-116

[2]

Cooper AD, 2009, ARCH NEUROL-CHICAGO, V66, P1505, DOI 10.1001/archneurol.2009.273

[3] General anesthetic-induced neurotoxicity: an emerging problem for the young and old? [J].

Culley, Deborah J. ;

Xie, Zhongcong ;

Crosby, Gregory .

CURRENT OPINION IN ANESTHESIOLOGY, 2007, 20 (05) :408-413

[4] Impaired acquisition of spatial memory 2 weeks after isoflurane and isoflurane-nitrous oxide anesthesia in aged rats [J].

Culley, DJ ;

Baxter, MG ;

Crosby, CA ;

Yukhananov, R ;

Crosby, G .

ANESTHESIA AND ANALGESIA, 2004, 99 (05) :1393-1397

[5] The memory effects of general anesthesia persist for weeks in young and aged rats [J].

Culley, DJ ;

Baxter, M ;

Yukhananov, R ;

Crosby, G .

ANESTHESIA AND ANALGESIA, 2003, 96 (04) :1004-1009

[6] Desflurane and isoflurane improve neurological outcome after incomplete cerebral ischaemia in rats [J].

Engelhard, K ;

Werner, C ;

Reeker, W ;

Lu, H ;

Möllenberg, O ;

Mielke, L ;

Kochs, E .

BRITISH JOURNAL OF ANAESTHESIA, 1999, 83 (03) :415-421

[7] Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits [J].

Jevtovic-Todorovic, V ;

Hartman, RE ;

Izumi, Y ;

Benshoff, ND ;

Dikranian, K ;

Zorumski, CF ;

Olney, JW ;

Wozniak, DF .

JOURNAL OF NEUROSCIENCE, 2003, 23 (03) :876-882

[8] Volatile anesthetics increase intracellular calcium in cerebrocortical and hippocampal neurons [J].

Kindler, CH ;

Eilers, H ;

Donohoe, P ;

Ozer, S ;

Bickler, PE .

ANESTHESIOLOGY, 1999, 90 (04) :1137-1145

[9] ISOFLURANE FOR REFRACTORY STATUS EPILEPTICUS - A CLINICAL-SERIES [J].

KOFKE, WA ;

YOUNG, RSK ;

DAVIS, P ;

WOELFEL, SK ;

GRAY, L ;

JOHNSON, D ;

GELB, A ;

MEEKE, R ;

WARNER, DS ;

PEARSON, KS ;

GIBSON, JR ;

KONCELIK, J ;

WESSEL, HB .

ANESTHESIOLOGY, 1989, 71 (05) :653-659

[10] Effects of volatile anesthetics on N-methyl-D-aspartate excitotoxicity in primary rat neuronal-glial cultures [J].

Kudo, M ;

Aono, M ;

Lee, Y ;

Massey, G ;

Pearlstein, RD ;

Warner, DS .

ANESTHESIOLOGY, 2001, 95 (03) :756-765