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Management of Status Epilepticus on the Intensive Care Unit 

Management of Status Epilepticus on the Intensive Care Unit
Chapter:
Management of Status Epilepticus on the Intensive Care Unit
Author(s):

Erich Schmutzhard

and Bettina Pfausler

DOI:
10.1093/med/9780199659043.003.0033
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date: 26 June 2022

A generalized status epilepticus (GCSE) is a neurologic emergency, if developing into a refractory GCSE a neurologic/neurocritical care catastrophy. Such a GCSE requires immediate full scale monitoring, including cardio-pulmonary monitoring, gas exchange monitoring, temperature and metabolic parameters need to be closely monitored as well as renal function being at risk due to pending rhabdomyolysis, acidosis, etc.The entire spectrum of potential neuronally damaging factors, lack of oxygen supply, deranged body temperature and metabolism add to neuronal damage which continues as a direct result of electrical seizures and neuronal depolarizations. This chapter outlines the indication for a patient with GCSE to be admitted to an intensive care unit, the stepwise increase of management intensity as well as the extremely large spectrum of adverse effects of GABA-mediated anaesthetic drugs as barbiturates and propofol. Furthermore, it describes the side effects of any type of treatment of GCSE ranging from hypoventilation, hypotension, cardiac arrhythmia, phlebitis, tissue necrosis, rhabdomyolysis, immunosuppression, impaired gastrointestinal motility and other complications. Finally unconventional therapies are discussed; they include ketamine, lidocaine, isoflurane, and hypothermia.

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