42M admitted with refractory status epilepticus. Given lorazepam 4mg IV (2 doses), no cessation. Levetiracetam 60mg/kg loading dose given. Continuous EEG shows generalized electrographic SE. Patient now intubated and in ICU. No structural lesion on emergent MRI. CSF normal. Autoimmune encephalitis panel pending. Per Neurocritical Care Society 2023 SE guidelines (Stage 4 RSE), should I start midazolam continuous infusion (titrate to burst suppression), or propofol? What are the risks of propofol infusion syndrome (PRIS)? When is ketamine or barbiturate coma indicated?
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