Seizures and Status Epilepticus

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Dr. Sachetti reviews seizures and status epilepticus.

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Jesse Q. -

In this video Dr. Sachetti recommends avoiding paralytics when intubating the status patient. In discussing this with providers in my group, most do use a paralytic in this circumstance, understanding the need for EEG monitoring if using a longer acting agent like Rocuronium. In C3 in August 2017, not only is the use of paralytics discussed, but the show notes states that Roc is preferred due to the risk of hyperK/rhabdo in the status patient.

Do others avoid using paralytics when intubating the status patient?

Alfred S. -

Jesse

If you need to intubate someone in status the idea is to try to do it without the use of a paralytic if possible. Combinations such as propofol and remifentanil are used to perform non-paralytic intubation. This is commonly done for thyroid surgery when monitoring vocal cord function.

However, as your colleagues note, when you need to paralyze a status patient, then rocuronium is the drug to use. One caveat, use a low dose. The muscles will be very fatigued, so a lower dose will work very quickly.

Jesse Q. -

Thank you. Safe to say 50% of normal paralytic dose? Example: 0.5mg/kg of rocuronium?

Alfred S. -

0.5 mg/kg would work perfect.

Al

Rory P. -

When using Ketamine to break seizure in this instance what dose is used? Is it given with the intent to intubate immediately after administration, or monitor for effect and then manage the airway if required?

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