Affiliation:
1. EEG and Epilepsy Unit, Department of Clinical Neurosciences University Hospital of Geneva Geneva Switzerland
2. Neuro‐Intensive Care Unit, Department of Intensive Care University Hospital of Geneva Geneva Switzerland
3. Clinic for Intensive Care Medicine University Hospital Basel Basel Switzerland
4. Department of Neurology University Hospital Basel Basel Switzerland
5. Medical faculty of the University of Basel Basel Switzerland
6. Medical Communication and Psychosomatic Medicine University Hospital Basel Basel Switzerland
7. Medical faculty of the University of Geneva Geneva Switzerland
Abstract
AbstractObjectiveThis study was undertaken to investigate the efficacy, tolerability, and outcome of different timing of anesthesia in adult patients with status epilepticus (SE).MethodsPatients with anesthesia for SE from 2015 to 2021 at two Swiss academic medical centers were categorized as anesthetized as recommended third‐line treatment, earlier (as first‐ or second‐line treatment), and delayed (later as third‐line treatment). Associations between timing of anesthesia and in‐hospital outcomes were estimated by logistic regression.ResultsOf 762 patients, 246 received anesthesia; 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia) and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (.5 vs. 1.5 days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional nonanesthetic antiseizure medication given prior to anesthesia (odds ratio [OR] = .71, 95% confidence interval [CI] = .53–.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the Status Epilepticus Severity Score (STESS; STESS = 1‐2: OR = .45, 95% CI = .27–.74; STESS > 2: OR = .53, 95% CI = .34–.85), especially in patients without potentially fatal etiology (OR = .5, 95% CI = .35–.73) and in patients experiencing motor symptoms (OR = .67, 95% CI = .48–.93).SignificanceIn this SE cohort, anesthetics were administered as recommended third‐line therapy in only every fifth patient and earlier in every second. Increasing delay of anesthesia was associated with decreased odds for return to premorbid function, especially in patients with motor symptoms and no potentially fatal etiology.
Funder
University Hospital Basel
Subject
Neurology (clinical),Neurology
Cited by
6 articles.
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