Related Experiment Videos
Respiratory depression in the acute management of seizures
W A Stewart1, R Harrison, J M Dooley
1Department of Pediatrics, Division of Pediatric Neurology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada. wastewar@is.dal.ca
Insights
Multiple benzodiazepine doses for prolonged seizures in children may increase respiratory depression risk. Even low doses, when repeated, were associated with this adverse event in a retrospective study.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Prolonged seizures in children require prompt treatment.
- Benzodiazepines are first-line agents for seizure termination.
- The risk of respiratory depression with benzodiazepines is not well-defined.
Purpose of the Study:
- To determine the incidence of respiratory depression after benzodiazepine treatment for prolonged seizures in children.
- To evaluate the association between benzodiazepine dosing strategies and respiratory depression.
Main Methods:
- Retrospective chart review of children treated for prolonged seizures over one year.
- Analysis of benzodiazepine agents used (lorazepam, diazepam), dosing frequency, and documented respiratory depression.
- Comparison of doses administered against recommended doses for status epilepticus.
Main Results:
- 56 prolonged seizures were reviewed; 30 received lorazepam, 19 diazepam, and 7 both.
- 39% of seizures required multiple benzodiazepine doses.
- 14% of events (8/56) had documented respiratory depression, with 6 of these occurring after multiple doses.
Conclusions:
- Multiple doses of benzodiazepines for prolonged seizures in children are associated with an increased risk of respiratory depression.
- Even doses at the lower end of recommended ranges may contribute to this risk when administered repeatedly.
Abstract:
The incidence of respiratory depression following treatment of prolonged seizures with benzodiazepines is variable in the literature. We retrospectively reviewed the charts of children treated for prolonged seizure over a one year period. Of the 56 seizures treated, 30 received lorazepam, 19 diazepam, and seven both drugs. Twenty two episodes (39%) of prolonged seizure were treated with multiple doses of benzodiazepines. In eight events (14%), there was documented respiratory depression following the administration of one or more doses of benzodiazepine; in six of these, multiple doses were given. The doses used were often at the low end or less than the recommended dose for treatment of status epilepticus. These data support suggestions that multiple doses of benzodiazepines increase the risk of respiratory depression.