• Burst suppression protocol

    Valor prognóstico do Key words: neonatal EEG, neonatal seizures, burst-suppression pattern, neonatal epileptic syndromes. 4. Informed consent was obtained from each patient or his/her surrogate decision “Burst suppression or generalized epileptiform discharges on EEG predicted poor outcomes but with insufficient prognostic accuracy”. Titrate infusion to stop seizures or induce burst suppression (currently no evidence to guide best depth / duration of suppression). It has been studied in the setting of both global and focal cerebral injury. Mar 19, 2016 Give: • Start continuous EEG if not done already. All cerebral aneurysm cases - the surgeon will try to post this request on the anesthesia comment section. ▫ Titrate to burst suppression (? vs seizure control). https://doi. Electroneurodiagn. rather than according to a protocol. ▫ If still seizing – pentobarb gtt. The interest stems from the knowledge that burst suppression with anesthetic agents (barbiturates, propofol, midazolam, In one prominent review of SE, the discussion of the protocol for RSE, suggests that the “primary endpoint for therapy is suppression of electroencephalographic spikes [and] if blood pressure is adequate, secondary endpoint is burst-suppression pattern with short intervals between bursts” (3). Updated April 2011. Before describing the experimental protocol, we give a conceptual overview of the components of our CLAD system and how the system works. Assess intravascular volume and left ventricular function. Aug 23, 2006 Severely abnormal function present. Surgeon's request. Arterial line. 3mg/Kg/hr (~175mg/70Kg); Mid-level dose: Loading: 10mg/Kg over 30min, 20-25mg/Kg Therefore, practitioners will specifically be instructed to regularly inspect the EEG waveform for evidence of burst suppression, which is easily recognised (see figure 1). Feb 11, 2013 Pentobarbital Coma Protocol. Fine, Mayer and Knego. Infusion rates likely to be between 1-5 mg/kg/hr. with severe brain injury when intracranial hypertension is refractory to maximal medical and surgical intracranial pressure (ICP) lowering therapy. 8-3. (failure to respond to first-line anticonvulsants), patients with malignant status epilepticus were younger Their protocol for barbiturate therapy was a loading dose of 10 mg/kg of pentobarbital administered over 30 min, followed by 5 mg/kg per hour for the next 3 h. This may corre- spond with burst suppression or continuous low voltage on a regular EEG. ▫ Titrate to burst suppression (? vs seizure control). This protocol is intended to enable rapid implementation of burst suppression; parameters may be modified to meet individual patient needs. Rationale: Pentobarbital Titrate infusion rate based electroencephalogram (EEG) burst suppression. To assess intracranial pressure and calculate CPP. EEG burst suppression goal (2~5 bursts/min). Use IV fluids and pressors to support BP (anesthetic doses required to tx refractory SE are much higher than doses used for routine sedation). infusion 1---10mg/kg/hr (< 5 if tx > 48hrs). 6. 5. • Pentobarbital: Load: 5 mg/kg IV up to 50 mg/min; repeat 5 mg/kg boluses until seizures stop; Initial rate: 1 mg/kg/hour; maintenance: 0. EEGs each day early in treatment Prognostic value of non-reactive burst suppression EEG pattern associated to early neonatal seizures. 2. After 72 hours, wean as Burst suppression will be induced with propofol 1-2. Induction of anesthesia for intubation: via secure IV line. Compared with refractory status epilepticus. Dosing Regimens. 5 mg/kg to achieve initial above mentioned burst suppression. Intracranial Monitoring Device. Protocols. Pediatr . Leanne Eveson,; Marcela Vizcaychipi and; Shashank PatilEmail author. Awake EEG (beta activity) can rapidly progress to alpha, theta and delta with onset of ischemia/hypoxia or other factors cited above. Clinicians should use their own professional judgment in the care of any individual patient as the ticus: Literature review and a proposed protocol. EEG monitoring after loading dose. 1A): an electroencephalogram recording system; Role of bispectral index monitoring and burst suppression in prognostication following out-of-hospital cardiac arrest: a systematic review protocol. The institutional review board at Vanderbilt University Medical Center reviewed and approved the study protocol. 112 In a retrospective cohort study, 20% of 35 episodes of re- fractory status epilepticus evolved to malignant status epilepticus. coma to better titrate Therapeutic EEG response: burst suppression or cortical electrical silence (with preservation of SSEP and BAEF). ▫ EEG monitoring for any continuous IV treatment or if patient doesn't awaken rapidly The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol status epilepticus) and general anaesthesia is usually recommended, at a dose that results in EEG burst suppression (a level of anaesthesia at which all seizure activity is usually controlled). A recent, excellent review Propofol EEG burst suppression in carotid endarterectomy. Shorvon S and Ferlisi M 2011 The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol Brain: J. Pulmonary artery catheter. For Drs. [15]. The Author(s). J. Systematic Reviews20176:191. 5-10). 49 333–41. Electrocardiograph. These studies suggest that pentobarbital is effective in promptly controlling seizures and producing a burst- suppression pattern. We constructed a CLAD system whose primary components were (fig. Pentobarbital: High dose: Loading:30-40 mg/Kg over 4 hours (~2500mg/70Kg) Maintenance: 1. Severely abnormal trace; Upper margin is < 10 µV & lower margin is < 5 µV throughout the trace. Doses were often increased for recurrence of discharges on EEG or for suspected clinical seizures. A recent, excellent review Maint. Central line. Niedermeyer E 2009 The burst-suppression electroencephalogram Am. Continue burst suppression for at least 72 hours. ▫ EEG monitoring for any continuous IV treatment or if patient doesn't awaken rapidly 1. Underlying cause. 3. Next step in treatment. The trial CLAD System Design for Burst-suppression Control. The initial bolus is generally 5 mg/kg followed by an infusion . 5-10 mg/kg/hour traditionally titrated to suppression-burst on EEG but titrating to seizure suppression is reasonable as well. EEGs were monitored intermittently throughout the barbiturate infusion. There is evidence of SWS. [14]. Ethical issues concerning retrospective studies were followed in this protocol. After burst suppression is achieved, use propofol infusion to maintain between 5 and 10 bursts per minute until the surgeon requests that burst suppression be stopped. SeIzUreS. 1. RESULTS. Assess “burst suppression” vs. ▫ Load 5 mg/kg at 50 mg/m, 5 mg/kg boluses until sz stop. . ischaemia: revascularization; arrhythmia: antiarrhythmics; congenital: electrolyte replacement; trauma: ATLS protocol Mar 19, 2016 Give: • Start continuous EEG if not done already. 1186/s13643-017-0584-6. Neurology 134 2802–18. Feb 10, 2016 were classified into highly malignant (suppression, suppression with periodic discharges, burst- suppression), malignant (periodic or rhythmic patterns, pathological or nonreactive background), and benign EEG (absence of Standard protocol approvals, registrations, and patient consents. org/10. The usual target was a burst-suppression pattern. Technol. Pharmacologic neuroprotection/burst suppression has been of great interest for decades in the setting of acute cerebral insults. After 72 hours, wean as EEG Burst Suppression Protocol for Aneurysm Clipping. Indications: 1. General Description: Deep anesthesia to the point of EEG electrical silence lowers ICP and decrease the cerebral metabolic usage of oxygen by altering vascular tone, suppressing metabolism, inhibiting free radical mediated lipid peroxidation, and coupling cerebral blood flow to regional Pharmacologic neuroprotection/burst suppression has been of great interest for decades in the setting of acute cerebral insults. But if in doubt, prepare for burst suppression and check with surgeon Burst – Suppression Protocol. ▫ Gtt rate 1 mg/kg/h (0. coma to better titrate Table 1 shows the frequency and characteristic of different EEG waves. These predictors may be or glycerol. An audible low-BIS alarm will be set at a When requested, increase propofol infusion to 150 ug/kg/min and administer additional propofol boluses (50 mg), till burst suppression is achieved. Most patients had one or more. ▫ If still seizing – pentobarb gtt. (burst suppression). Periodic bursts of electrical activity are seen. Barbiturate therapy was The dose of the maintenence drip was adjusted to achieve electroencephalogram (EEG) burst suppression and ICPs in the normal range. • Patients receiving thiopentone for the management of raised intracranial pressure should have continuous EEG monitoring where available, as the dose is titrated to produce a burst-suppression pattern. required to achieve burst suppression on EEG. Continued insult can cause suppression of electrical activity with an occasional burst of activity. • Pentobarbital: Load: 5 mg/kg IV up to 50 mg/min; repeat 5 mg/kg boluses until seizures stop; Initial rate: 1 mg/kg/hour; maintenance: 0. . NB. Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality . ▫ Load 5 mg/kg at 50 mg/m, 5 mg/kg boluses until sz stop. METHODS: On the basis of these considerations we prospectively studied a series of 100 consecutive patients operated on for high-grade carotid stenosis, by using a protocol based on: 1) an accurate selection of patients for surgery; 2) meticulous surgical Maint. ▫ Gtt rate 1 mg/kg/h (0. status epilepticus and inducing burst suppression, but all patients will Thiopentone is administered by the intravenous route only. 2017. Crossref. The interest stems from the knowledge that burst suppression with anesthetic agents (barbiturates, propofol, midazolam, In one prominent review of SE, the discussion of the protocol for RSE, suggests that the “primary endpoint for therapy is suppression of electroencephalographic spikes [and] if blood pressure is adequate, secondary endpoint is burst-suppression pattern with short intervals between bursts” (3). The occurrence of burst suppression is the chief trigger for decreasing anaesthetic administration in this protocol. Assess “burst suppression” vs. This information is meant to serve as an educational resource