Epilepsi dan anestesi

Status epileptikus dan anestesi: 

Status epileptikus dan anestesi Dr. Ardi Pramono, SpAn, MKes

Status epileptikus: 

Status epileptikus Merupakan bangkitan kejang yang tidak berhenti sampai 30 menit Berlangsung terus menerus atau ada episode berhenti Etiologi: Acute symptomatic (26%) - Episodes caused by an acute infection, head trauma , hypoxemia, electrolyte disturbance, hypoglycemia , intoxication or drug withdrawal Progressive encephalopathy (3%) – Status epilepticus occurring with an underlying progressive CNS disorder

Slide 3: 

Remote symptomatic status epilepticus (33%) - A status epilepticus secondary to static conditions (eg, remote cerebral insult in the perinatal period) Remote symptomatic with an acute precipitant (1%) – Status epilepticus that occurs with a chronic encephalopathy but with an acute precipitant such as the same reported in acute symptomatic

Slide 4: 

Febrile (22%) – Status epilepticus that occurs when the only provocation is a febrile illness, after excluding a direct CNS infection Cryptogenic (15%) – Status epilepticus that occurs without identifiable cause

Patofisiologi: 

Patofisiologi Result of a failure of the normal factors that serve to terminate a typical seizure, such as changes in GABA receptor composition, loss of benzodiazepines efficacy, excessive glutamate excitation, and activation of drug resistance genes

Mortalitas dan morbiditas: 

Mortalitas dan morbiditas Studies of outcomes conducted over the past 15 years report low morbidity and mortality among pediatric patients with status epilepticus. Among children with generalized tonic-clonic status epilepticus, sequelae occurred in 9% of cases. Of these, approximately 58% were only motor sequelae, 29% were motor and cognitive, and 13% were only cognitive

Mortalitas: 

Mortalitas 12% pada pediatrik dengan kejang akut dan encephalopaty Pada dewasa lebih meningkat Kejang sampai 90 menit brain damage (pada baboon)

Penanganan : 

Penanganan Always ABC, miringkan pasien, monitor VS Obat-obatan: 6-15 menit: Benzodiazepin (diazepam 5-20 mg iv atau lorazepam 2-4 mg 16-35 menit: Fenitoin 20 mg/kg iv >35 menit : Midazolam, Pentotal, propofol (anestesi umum)

Komplikasi: 

Komplikasi Hipotensi, depresi kardiak, depresi napas. Pulih sadar cepat dengan propofol

Alhamdulillah, Terimakasih www.bumiabdi.blogspot.com: 

Alhamdulillah, Terimakasih www.bumiabdi.blogspot.com