Can anesthesia cause seizures
Neurology , topic 1 , seizures , focal seizures , types
Context AND OBJECTIVES: One of the most common chronic neurological disorders is epilepsy. While epilepsy patients are more commonly anesthetized in neurosurgery, this category of patients, like the general population, requires anesthesia for a variety of diagnostic and therapeutic procedures. This article focuses on the concerns that concern anesthesiologists the most in the perioperative treatment of epileptic patients undergoing non-neurosurgical procedures.
CONTENT: We cover topics such as epilepsy pathophysiology, classification, and diagnosis; anticonvulsant therapy and interactions with anesthetic medications; surgery and the ketogenic diet; pro- and anticonvulsant effects of drugs used in anesthesia; preoperative assessment, intra- and postoperative behavior in epileptic patients; and the diagnosis and treatment of perioperative seizures.
CONCLUSIONS: In the perioperative management of epileptic patients, anesthesiologists must identify the type of epilepsy, the frequency, severity, and factors triggering epileptogenic crises; the use of anticonvulsant drugs and possible interactions with anesthesia drugs; the use of a ketogenic diet and vagus nerve stimulators, and their implications in anesthesiology. Understanding the pro- and anticonvulsant properties of medications used in anesthesia is important for reducing the risk of seizure activity during and after surgery. Finally, it is important to outline the diagnosis and treatment of seizures during the perioperative period, since this decreases both morbidity and mortality.
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In the United States and around the world, epilepsy is one of the most common neurological conditions. It affects 0.5-1 percent of the population, with a 10% chance of having a single seizure in their lifetime. In the intraoperative, emergency, and intensive care unit settings, anesthesiologists are often faced with the treatment of seizures in epileptic and non-epileptic patients. This review focuses on neurosurgical populations and aims to provide an update on the pathophysiology, clinical presentation, and treatment strategies of perioperative seizures, as well as the pro- and anti-convulsant properties of anesthetic agents.
Seizures are the clinical expression of irregular electrical activity in the brain that is more coordinated. They arise from a hyperexcitable region of the brain where synchronized electrical activity has developed [1,2]. Recurrent seizures unprovoked by an acute systemic or neurologic insult are characterized as epilepsy .
Epilepsy affects nearly 50 million people worldwide. The average incidence of new cases in developed countries is 6-10 per 1000 people . Numerous reports of perioperative seizures have been reported in medical literature since the introduction of anesthesia into medical practice. Many anesthetic drugs have been shown to raise or lower seizure thresholds. Despite this, the prevalence, risk factors, pathophysiological processes, and prophylactic steps associated with anesthetic drug-induced seizures are still unknown.
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Intracranial hypotension caused by surgical damage to the dura mater was linked to adverse intracranial events following spinal surgery.
Presentation of a case
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Under general anesthesia, a 72-year-old woman had posterior lumbar interbody fusion. She experienced generalized seizure soon after being transferred to the supine position and the muscle relaxants were reversed. Propofol was used to stop the seizure right away. The computed tomography scan of the brain was unremarkable. Despite her return to the surgical suite, no apparent point of dural laceration was discovered. Fibrin glue was used to cover the dura. On the first postoperative day, magnetic resonance imaging showed a subarachnoid hemorrhage (SAH). The seizure had stopped by the second postoperative day. SAH due to intracranial hypotension was suspected as the cause of her seizure. Anesthesia and muscle relaxation were used to mask the seizure. Final Thoughts While spinal surgeries are a common procedure, the potential for life-threatening complications must be carefully considered.
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The neurologic complications of drugs used for local anesthesia, as well as the procedures involved, are the subject of this report. Seizures are the most common side effects of local anesthetics. Sensory and motor neurologic deficits are often associated with blocked nerves. These may be temporary or long-term. Adjuvant agents, which are used to improve the effectiveness of local anesthetics, may have neurotoxic side effects. There are suggestions for reducing the neurologic problems associated with local anesthesia.
When local anesthetics are administered to body tissues, they induce a reversible loss of sensation or analgesia. This is done by interfering with peripheral nerve conduction.
The application of substances directly to the wound to induce analgesia dates back to the beginning of medical history. Arab doctors used opium as a local anesthetic in patients with dental pain, earaches, or joint pain about 1000 years ago (Al-Mazrooa and Abdel-Halim 1989). Cocaine was the first modern local anesthetic, discovered in 1860 from the leaves of Erythroxylum coca. It was first used as a topical anesthetic for the eyes in 1884, and its local anesthetic properties on the skin were identified in 1880. (Koller 1884). Since the 1960s, syncope and seizures have been identified as side effects of local anesthesia. Cocaine’s neurologic side effects have been well reported (Jain 2020). Cocaine’s use as a local anesthetic has diminished due to its misuse potential and neurotoxicity. Since it is the only drug that has both local anesthetic and vasoconstrictor effects, it is often used in endonasal surgery. Alternatives include safer local anesthetics that can be paired with 1:1000 epinephrine for a vasoconstrictor impact.