Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus
Abstract
:1. Introduction
2. Approach to cIV Anesthetic Use
3. Benzodiazepines: Midazolam
4. Propofol
5. Barbiturates: Pentobarbital and Thiopental
6. Ketamine
7. Controversies of Prolonged Anesthetic Use
8. Conclusions
Author Contributions
Conflicts of Interest
References
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Mechanism of Action | Metabolism | Active Metabolite | Half-Life (Hours) | Half-Life Considerations | Drug Interactions | Examples of Drug-Drug Interactions | Adverse Reactions | |
---|---|---|---|---|---|---|---|---|
Midazolam | GABA agonist | Hepatic | 1-hydroxy-midazolam (renally eliminated) | 2–7 | Duration prolonged in renal failure and with extended duration of use | CYP 3A4 substrate | Phenytoin and phenobarbital (CYP 3A4 inducers) → lower midazolam concentrations |
|
Propofol | GABA agonist; NMDA antagonist properties | Hepatic | N/A | 0.5–7 | Duration may be prolonged with extended duration of use | N/A | N/A |
|
Pentobarbital | GABA agonist; Barbiturate | Hepatic | N/A | 15–50 | Duration may be prolonged with extended duration of use | CYP 2A6 inducer | Valproate (decreases barbiturate metabolism) → May increase pentobarbital concentrations Lamotrigine (CYP 2A6 substrate) → pentobarbital lowers lamotrigine concentrations |
|
Ketamine | NMDA antagonist | Hepatic | Norketamine (hepatically eliminated) | 2.5 | N/A | CYP 2C9 & 3A4 substrate | Phenytoin and phenobarbital (CYP 2C9 inducers) → lower ketamine concentrations |
|
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Reznik, M.E.; Berger, K.; Claassen, J. Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus. J. Clin. Med. 2016, 5, 54. https://doi.org/10.3390/jcm5050054
Reznik ME, Berger K, Claassen J. Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus. Journal of Clinical Medicine. 2016; 5(5):54. https://doi.org/10.3390/jcm5050054
Chicago/Turabian StyleReznik, Michael E., Karen Berger, and Jan Claassen. 2016. "Comparison of Intravenous Anesthetic Agents for the Treatment of Refractory Status Epilepticus" Journal of Clinical Medicine 5, no. 5: 54. https://doi.org/10.3390/jcm5050054