A survey of the safe usage of intravenous anticonvulsants

Abstract

  Objective: This survey aimed to determine the current usage and adverse events associated with intravenous (IV) anticonvulsants, to better understand their safety profile. Methods: We issued web-based questionnaires to 1,118 pediatric neurologists in Japan to gather information on IV anticonvulsant usage at the time of convulsions and associated adverse events in children younger than 15 years in 2015. Results: Out of the 145 respondents (13.0% response rate), 2,355 events associated with IV anticonvulsants were reported by 86 pediatric neurologists. The majority of the injections comprised midazolam (MDL), diazepam (DZP), and fosphenytoin (FOS). For drugs administered for off-label use, DZP enema (22 cases), intranasal MDL (50 cases), MDL IV infusion for children younger than 45 weeks after correction for gestational age (26 cases), FOS IV infusion for children younger than 2 years (72 cases), and thiopental/thiamylal IV infusion (128 cases) were reported. There was one adverse event that led to respiratory arrest and 24 cases of other adverse events for which patients required intensive care and intervention. Conclusions: Including off-label usage, a large proportion of IV anticonvulsants was safely administered ; however, adverse events occurred in some cases. As most IV anticonvulsants are administered to patients with status epilepticus, not all the adverse events may be related to the anticonvulsants, and the rapid responses that occurred after the convulsions themselves may be included ; however, more attention should be paid to emergency treatment.