Introduction- There are no comprehensive trials on use of inhalational anaesthetics in Super Refractory Status Epilepticus (SRSE). We describe the use of Isoflurane in our cases of SRSE with its presentation and outcomes.

Methodology- Retrospective chart review of cases with SRSE in a tertiary care hospital in a city.

Results – Isoflurane was started in 8 of 18 children with SRSE, aged 1.5-10.5 years (mean- 5.5years) between April2014 –May2018. Etiology was identified in 3/8 children (1 had focal cortical dysplasia, 1 had ALDH7A mutation and 1 had mycoplasma encephalitis). At presentation 3 had focal seizures ,4 had generalised seizures and 1 had both focal and generalised seizures. Isoflurane was initiated between day2- day18 of status epilepticus after failure of midazolam, ketamine,thiopentone or propofol. It was given at a dose between 0.3-2 MAC (minimal alveolar concentration) titrating with clinical, electrographic seizures and duration of suppression on EEG. Duration of administration ranged from 36 hours to 18 days. Amelioration of clinical seizures in all 7/7 with convulsive SRSE and burst suppression on EEG in all 8 children. All 8 had hypotension, required ionotropes ,not requiring withdrawal of Isoflurane .Clinical seizures recurred in 6/8 on stopping Isoflurane. Three /eight died and 5/8 survived. There was cognitive improvement in 4/5 survivors none reaching baseline, motor recovery in 5/5 and 3/5 continued to have seizures on follow up.

Conclusion- Isoflurane was the most effective drug for convulsive seizures when others drugs fail and early use can reduce the number of other medication use.