Continuous infusion pentobarbital for refractory status epilepticus in children

• Published in: Journal of child neurology Vol. 27; no. 6; p. 721
• Main Authors: Barberio, Michael, Reiter, Pamela D, Kaufman, Jon, Knupp, Kelly, Dobyns, Emily L
• Format: Journal Article
• Language: English
• Published: United States 01.06.2012
• Subjects: Adolescent; Child; Child, Preschool; Drug Administration Schedule; Electroencephalography; Female; Humans; Hypnotics and Sedatives - administration & dosage; Infant; Infant, Newborn; Infusions, Intravenous - methods; Male; Neurologic Examination; Pentobarbital - administration & dosage; Retrospective Studies; Status Epilepticus - drug therapy; Treatment Outcome
• ISSN: 1708-8283
• DOI: 10.1177/0883073811424941

The purpose of this retrospective medical chart review was to describe dosing regimens and outcomes in children who received continuous pentobarbital therapy for refractory status epilepticus. Thirty patients (age = 6.5 ± 5.1 years; 67% male) received a mean loading dose of 5.4 ± 2.8 mg/kg with an initial infusion of 1.1 ± 0.4 mg/kg/h. Maximum infusion dose was 4.8 ± 2 mg/kg/h. Thirty-three percent of patients achieved sustained burst suppression without relapse; 66.7% experienced relapse, but 60% of those (n = 12) eventually reachieved burst suppression. Children achieving burst suppression within 24 hours of pentobarbital initiation and those older than age 5 years were 1.5 times more likely to have a positive outcome. None of these variables, however, achieved significance (Fisher exact test). Ninety-three percent of patients required inotropes; 66% acquired an infection; 10% had metabolic acidosis; and 10% experienced pancreatitis. Poor outcomes (death, encephalopathy) were observed in 33% of patients.