Seizures

Question 1

Why is Lorazepam preferred to other benzos for the treatment of status epilepticus

Answer 1

Lorazepam antiseizure effect 12 - 24 hours

Diazepam antiseizure effect 15 - 30 minutes

Question 2

Describe the algorithm for the management of status epilepticus

Answer 2

HHH. ABCDE (NB position safe and recovery position)

1. Lorazepam 0.1 mg/kg + Phenytoin 20mg/kg @ 50 mg/minutes (over 20 - 30 minutes) (2nd dose of lorazepam if required)
2. Phenytoin 10mg/kg @ 50 mg/hour
3. Phenobarbitone 20mg/kg @ 50mg/min
   OR
4. Valproate 15mg/kg over 5 minutes
5. Phenobarb 10mg/kg @ 50mg/min
   OR
6. Valproate 15mg/kg over 5 mins

Admit to ICU. ETT. EEG.
General Anaesthesia
1. Propofol 2mg/kg bolus. Maintain 2 - 10 mg/kg/hour (titrate EEG: No seizure activity and No burst suppression)
OR
Midazolam
OR
Thipentone

Question 3

What actions should be taken if there is ongoing seizure activity after the initial phenytoin loading dose has just completed?

Answer 3

Brain concentration of phenytoin is maximal at the end of the infusion. Therefore, proceed to next step and do not wait and observe for effect