To investigate efficacy, tolerability and outcome of different timing of anesthesia in adult patients with status epilepticus (SE).
Patients with anesthesia for SE from 2015-2021 at two Swiss academic medical centers were categorized as anesthetized as recommended third-line treatment, earlier (as first- or second-line), and delayed (later as third-line). Associations between timing of anesthesia and in-hospital outcomes were estimated by logistic regression.
246 of 762 patients received anesthesia. 21% were anesthetized as recommended, 55% earlier, and 24% delayed. Propofol was preferably used for earlier (86% vs. 55.5% for recommended/delayed anesthesia), and midazolam for later anesthesia (17.2% vs. 15.9% for earlier anesthesia). Earlier anesthesia was statistically significantly associated with fewer infections (17% vs. 32.7%), shorter median SE duration (0.5 vs. 1.5days), and more returns to premorbid neurologic function (52.9% vs. 35.5%). Multivariable analyses revealed decreasing odds for return to premorbid function with every additional non-anesthetic antiseizure medication given prior to anesthesia (odds ratio[OR]=0.71, 95% confidence interval[CI] 0.53-0.94) independent of confounders. Subgroup analyses revealed decreased odds for return to premorbid function with increasing delay of anesthesia independent of the status epilepticus severity score (STESS1-2: OR=0.45, 95%CI 0.27-0.74; STESS>2: OR=0.53, 95%CI 0.34-0.85), especially in patients without potentially fatal etiology (OR=0.5, 95%CI 0.35-0.73), and in patients experiencing motor symptoms (OR=0.67, 95%CI 0.48-0.93).
In this SE cohort, anesthetics were administered as recommended third-line therapy in only every fifth patient and earlier in every second. Increasing delay of anesthesia was associated with decreased odds for return to premorbid function, especially in patients with motor symptoms and no potentially fatal etiology.

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