Related Experiment Videos
[Comparative non-randomized study with midazolam versus thiopental in children with refractory status epilepticus]
1Centro de Ciênicas Biológicas e da Saúde, Pontifícia Universidade Católica do Paraná. fredd@rla01.pucpr.br
Insights
Midazolam and thiopental showed similar seizure control for refractory status epilepticus (RSE) in children. However, midazolam resulted in fewer complications, though some patients experienced psychological side effects after treatment cessation.
Area of Science:
- Pediatric Intensive Care Medicine
- Neurology
- Clinical Pharmacology
Background:
- Refractory status epilepticus (RSE) in children poses significant treatment challenges.
- Established treatments often involve barbiturates, but efficacy and safety can be concerns.
Purpose of the Study:
- To compare the efficacy and safety of midazolam versus thiopental for managing pediatric refractory status epilepticus.
- To evaluate complications and treatment outcomes associated with each agent.
Main Methods:
- A prospective study (Midazolam Group) compared with a historical control group (Thiopental Group) involving 50 children with RSE.
- Both groups received prior treatment with benzodiazepines and diphenylhydantoin.
- Dosage regimens included intravenous bolus followed by continuous infusion for both midazolam and thiopental.
Main Results:
- No statistically significant difference was found in the time to seizure control or overall effectiveness between midazolam and thiopental.
- The midazolam group experienced significantly fewer complications, including reduced cyanosis (p=0.00006) and no requirement for respiratory support (p<0.00001).
- Post-treatment psychological disorders, such as confusion and agitation, were observed in 12.5% of patients in the midazolam group.
Conclusions:
- Midazolam offers a favorable safety profile compared to thiopental for pediatric RSE, with significantly fewer complications.
- While effective, midazolam use requires monitoring for potential post-treatment psychological adverse effects in children.
Abstract:
We evaluated the use of midazolam versus thiopental in 50 children with refractory status epilepticus (RSE), admitted in a pediatric intensive care unit. The study consisted of two groups of patients: Group A - Midazolam, a prospective study, and Group B - Thiopental, a historical group. These patients already had previous medication with benzodiazepin and diphenylhydantoin and other drugs. When there was no effective control of the seizures, the patients of Group A received midazolam of 200 microg/kg intravenous in bolus, being followed by continuous intravenous infusion at the rate 0. 25-15 microg/kg/min. Group B received thiopental 1 mg/kg intravenous in bolus followed by continuous intravenous infusion at the rate of 10-120 microg/kg/min. In relation to the time of seizure control and effectiveness, there was no statistical significance for the two groups. The Midazolam Group had significantly less complications during the treatment: less cyanosis (p=0.00006), and they did not need respiratory support (p<0.00001). When the therapy with midazolam was ceased, 12.5% of the patients from this group showed psychological disorders such as mental confusion, aggressive behavior, restlessness, hallucinations and agitation.