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Status epilepticus.

W D Shields
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Abstract

Status epilepticus generally is considered to be a medical emergency requiring immediate intervention to prevent permanent injury to the brain. Tonic-clonic status epilepticus is a very frightening event; the inexperienced parents invariably believe that their child is dying. Emergent management is imperative for convulsive tonic-clonic (grand mal) status epilepticus, but there are nonconvulsive types of status epilepticus in which the problem is more one of correct diagnosis than emergent management. This article reviews aspects of status epilepticus, particularly the classification and treatment of the various types of status.

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Anesthesia, GeneralAnticonvulsantsBrain Damage, ChronicChild, PreschoolHumansInfantStatus EpilepticusJournal ArticleReview

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BibTeXRIS

W D Shields. 1989. Status epilepticus.. https://doi.org/10.1016/s0031-3955(16)36655-x

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Stereoselective pharmacokinetics of ketamine and norketamine after racemic ketamine or S-ketamine administration during isoflurane anaesthesia in Shetland ponies.

BACKGROUND: The arterial pharmacokinetics of ketamine and norketamine enantiomers after racemic ketamine or S-ketamine i.v. administration were evaluated in seven gelding ponies in a crossover study (2-month interval). METHODS: Anaesthesia was induced with isoflurane in oxygen via a face-mask and then maintained at each pony's individual MAC. Racemic ketamine (2.2 mg kg(-1)) or S-ketamine (1.1 mg kg(-1)) was injected in the right jugular vein. Blood samples were collected from the right carotid artery before and at 1, 2, 4, 8, 16, 32, 64, and 128 min after ketamine administration. Ketamine and norketamine enantiomer plasma concentrations were determined by capillary electrophoresis. Individual R-ketamine and S-ketamine concentration vs time curves were analysed by non-linear least square regression two-compartment model analysis using PCNonlin. Plasma disposition curves for R-norketamine and S-norketamine were described by estimating AUC, C(max), and T(max). Pulse rate (PR), respiratory rate (R(f)), tidal volume (V(T)), minute volume ventilation (V(E)), end-tidal partial pressure of carbon dioxide (PE'(CO(2))), and mean arterial blood pressure (MAP) were also evaluated. RESULTS: The pharmacokinetic parameters of S- and R-ketamine administered in the racemic mixture or S-ketamine administered separately did not differ significantly. Statistically significant higher AUC and C(max) were found for S-norketamine compared with R-norketamine in the racemic group. Overall, R(f), V(E), PE'(CO(2)), and MAP were significantly higher in the racemic group, whereas PR was higher in the S-ketamine group. CONCLUSIONS: Norketamine enantiomers showed different pharmacokinetic profiles after single i.v. administration of racemic ketamine in ponies anaesthetised with isoflurane in oxygen (1 MAC). Cardiopulmonary variables require further investigation.

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