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Intravenous benzodiazepines,especially diazepam,are widely recommended as first line treatment for status epilepticus but not for serial seizures. They penetrate the brain rapidly and thus quickly control seizures, although concentrations also fall quickly so that seizures may recur;the failure rate of the drugs is highest in patients with acute brain lesions. Intravenous benzodiazepines are also used as sedatives to allow a variety of invasive procedures including endoscopy.The drugs have,however,been associated with decreased arterial oxygen concentrations and cardiovascular depression,which are particularly dangerous in patients with pre-existing neurological conditions.Intracranial pressure may be raised and autoregulation defective in such patients,and a drop in perfusion pressure combined with a reduction in blood oxygenation may produce irreversible neurological damage.We have found that benzodiazepines are used inappropriately,often with risk to patients who have head injuries,spontaneous intracranial haemorrhages,or other acute neurological conditions. |
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