Propofol induced refractory status epilepticus

Study affiliation: Doctor Soliman Fakeeh Hospital, Jeddah Saudi Arabia.
Curr Pediatr Res 2010; 14 (1): 43-45
Successful treatment of Propofol induced refractory status epilepticus with calcium gluconate
Rafat Mosalli
Department of Pediatrics, Omm Al-Qura University, Mecca, Saudi Arabia
Abstract
Propofol-induced seizure-like phenomena (SLP) is well described following anesthesia or sedation with this drug. The episode is usually benign and responds well to standards anti-convulsant therapy. The occurrence of status epilepticus refractory to conventional treat-ment and successful treatment with intravenous Calcium has been rarely reported. We de-scribe a patient who developed status epilepticus refractory to standard treatment during recovery from Propofol anesthesia and successfully treated with intravenous calcium. The report highlights a potentially harmful complication of the Propofol and suggests that intra-venous calcium may be effective as an anticonvulsant treatment for Propofol-induced status epilepticus.
Key words: Propofol, seizure, calcium , status epilepticus.

Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation — Br J Anaesth

Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation — Br J Anaesth

Summary

The cost-effectiveness of sugammadex for the routine reversal of muscle relaxation produced by rocuronium or vecuronium in UK practice is uncertain. We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular block (NMB) produced by rocuronium or vecuronium. The economic assessment aimed to establish the reduction in recovery time and the ‘value of time saved’ which would be necessary for sugammadex to be potentially cost-effective compared with existing practice. Three trials indicated that sugammadex 2 mg kg⁻¹ (4 mg kg⁻¹) produces more rapid recovery from moderate (profound) NMB than neostigmine/glycopyrrolate. The economic assessment indicated that if the reductions in recovery time associated with sugammadex in the trials are replicated in routine practice, sugammadex would be cost-effective if those reductions are achieved in the operating theatre (assumed value of staff time, £4.44 per minute), but not if they are achieved in the recovery room (assumed value of staff time, £0.33 per minute). However, there is considerable uncertainty in these results. Sugammadex has the potential to be cost-effective compared with neostigmine/glycopyrrolate for the reversal of rocuronium-induced moderate or profound NMB, provided that the time savings observed in trials can be achieved and put to productive use in clinical practice. Further research is required to evaluate the effects of sugammadex on patient safety, predictability of recovery from NMB, patient outcomes, and efficient use of resources