Comparison of induction agents for rapid sequence intubation in refractory status epilepticus: A single-center retrospective analysis

Matthew R. Woodward; Adam Kardon; Jody Manners; Samantha Schleicher; Melissa B. Pergakis; Prajwal Ciryam; Jamie Podell; William Denney Zimmerman; Samuel M. Galvagno, Jr; Bilal Butt; Jennifer Pritchard; Gunjan Y. Parikh; Emily J. Gilmore; Neeraj Badjatia; Nicholas A. Morris

Epilepsy & Behavior Reports (Jan 2024)

Comparison of induction agents for rapid sequence intubation in refractory status epilepticus: A single-center retrospective analysis

Matthew R. Woodward,
Adam Kardon,
Jody Manners,
Samantha Schleicher,
Melissa B. Pergakis,
Prajwal Ciryam,
Jamie Podell,
William Denney Zimmerman,
Samuel M. Galvagno, Jr,
Bilal Butt,
Jennifer Pritchard,
Gunjan Y. Parikh,
Emily J. Gilmore,
Neeraj Badjatia,
Nicholas A. Morris

Affiliations

Matthew R. Woodward: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA; Corresponding author at: University of Maryland Medical Center, 22 S. Greene St., G7K18, Baltimore, MD 21201.
Adam Kardon: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Jody Manners: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Samantha Schleicher: Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Melissa B. Pergakis: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Prajwal Ciryam: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Jamie Podell: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
William Denney Zimmerman: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Samuel M. Galvagno, Jr: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
Bilal Butt: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Jennifer Pritchard: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
Gunjan Y. Parikh: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Emily J. Gilmore: Department of Neurology, Yale University School of Medicine, 20 York Street, New Haven, CT, USA
Neeraj Badjatia: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA
Nicholas A. Morris: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD, USA

Journal volume & issue: Vol. 25
p. 100645

Abstract

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Endotracheal intubation, frequently required during management of refractory status epilepticus (RSE), can be facilitated by anesthetic medications; however, their effectiveness for RSE control is unknown. We performed a single-center retrospective review of patients admitted to a neurocritical care unit (NCCU) who underwent in-hospital intubation during RSE management. Patients intubated with propofol, ketamine, or benzodiazepines, termed anti-seizure induction (ASI), were compared to patients who received etomidate induction (EI). The primary endpoint was clinical or electrographic seizures within 12 h post-intubation. We estimated the association of ASI on post-intubation seizure using logistic regression. A sub-group of patients undergoing electroencephalography during intubation was identified to evaluate the immediate effect of ASI on RSE. We screened 697 patients admitted to the NCCU for RSE and identified 148 intubated in-hospital (n = 90 ASI, n = 58 EI). There was no difference in post-intubation seizure (26 % (n = 23) ASI, 29 % (n = 17) EI) in the cohort, however, there was increased RSE resolution with ASI in 24 patients with electrographic RSE during intubation (ASI: 61 % (n = 11/18) vs EI: 0 % (n = 0/6), p =.016). While anti-seizure induction did not appear to affect post-intubation seizure occurrence overall, a sub-group of patients undergoing electroencephalography during intubation had a higher incidence of seizure cessation, suggesting potential benefit in an enriched population.

Published in Epilepsy & Behavior Reports

ISSN: 2589-9864 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system; Science: Physiology: Neurophysiology and neuropsychology
Website: https://www.journals.elsevier.com/epilepsy-and-behavior-reports

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