Bowel Ischemia: A Rare Complication of Thiopental Treatment for Status Epilepticus
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PRACTICAL PEARL
Bowel Ischemia: A Rare Complication of Thiopental Treatment for Status Epilepticus Carlo Cereda Æ Mette M. Berger Æ Andrea O. Rossetti
Published online: 25 November 2008 Ó Humana Press Inc. 2008
Abstract Background Refractory status epilepticus (RSE) treatment is usually performed with comainduction using an appropriate general anesthetic. Most frequent complications are represented by hypotension and infection. Other side-effects may however be encountered. Observations We describe two patients suffering from acute bowel ischemia after thiopental (THP) treatment for RSE. A 73-year-old man with a complex-patial RSE following an acute stroke received THP (303 mg/kg over 48 h); 36 h after THP discontinuation, he presented abdominal tenderness and lactate elevation. Necrosis of the terminal ileum and colon was seen during surgical exploration; he deceased shortly thereafter. A 21 year-old woman had a cryptogenic de novo generalized-convulsive RSE resistant to 5 attempts of EEG burst-suppression. During the 6th attempt, after THP (840 mg/kg over 150 h) together with mild hypothermia, she developed an ileus with elevated serum lactate; caecum necrosis was observed during surgery. Hypernatremia, acidosis and hyperlactatemia heralded this complication in both patients. Conclusion In these two patients, mechanical vascular ischemia may have resulted from drug-induced paralytic
ileus. To our knowledge, this is the first report describing this potential fatal side effect in adults with RSE. Keywords Thiopental Epilepsy Refractory status epilepticus Bowel ischemia
Status epilepticus (SE) has a yearly incidence of 10 to 41/ 100,000 and is the second most common life-threatening neurological emergency after stroke [1]. Refractory status epilepticus (RSE) is considered when administration of benzodiazepines and second line AEDs (e.g. phenytoin, valproic acid, or phenobarbital) fail to control SE [2]. Treatment of RSE aims at EEG background suppression with an appropriate anesthetic agent, such as midazolam, propofol, or barbiturates (thiopental (THP) in Europe; or pentobarbithal in North America) [3, 4]. Most cited complications related to these agents are represented by arterial hypotension, ‘‘infusion syndrome’’, or infections [3, 5, 6]. We report here on two patients with RSE, who underwent THP treatment for RSE and suffered from acute bowel ischemia, which appears to represent a rare but potentially fatal complication.
This paper was presented in part at the 18th Meeting of the European Neurological Society, Nice (F), 7–11 June 2008.
Patient 1 C. Cereda A. O. Rossetti (&) Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CHUV BH-07, Lausanne 1011, Switzerland e-mail: [email protected] M. M. Berger Department of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
A 73-year-old man presented an acute-onset language disturbance and was admitted to our emergency department. His pas
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