Propofol in the treatment of refractory status epilepticus

Objectives: To study prospectively the effects of propofol anesthesia on seizure control, hemodynamics and course of intensive care in patients with refractory status epilepticus. Design and setting: Prospective observational study in the general intensive care unit in a tertiary university hospital. Patients: Ten patients with refractory status epilepticus. Interventions: Patients received propofol anesthesia aiming to burst suppression EEG pattern for 12 h. Measurements and results: Dose of propofol, quality of burst suppression EEG, hemodynamics and the course of intensive care were recorded. Clinical and electrophysiological seizures terminated quickly, but maintaining burst suppression EEG pattern required incremental doses of propofol. Despite high doses of propofol, recovery from anesthesia was fast. Conclusions: High doses of propofol are needed in the treatment of refractory status epilepticus. The maintenance of continuous-burst suppression is difficult, and vigilant titrating of dosage of propofol is necessary under continuous EEG monitoring.