anaesthesia and epilepsy

1. Anaesthesia & Epilepsy
Moderator : Dr. Mukilan
Presenter : Emayah Tenzing

2. Why anaesthetists should be
concerned?
 Perioperative drug interactions
 Perioperative predisposition for
seizures
 Epileptogenic potential for certain
anaesthetic drugs.
 Airway management and general
anaesthesia for refractory status
epilepticus.

4.  What is epilepsy?
 What is a seizure?
 What is status epilepticus?

5. Classification of seizures:

6. Investigations
 Electroencephalography
 Electrocorticography
 MRI/ Fmri Brain
 PET/SPECT

7. Management
Medical Surgical

8. Basis of epilepsy and
treatment
• Glutamate
• Increase?
• decrease?
Excitotoxic
• GABA
• Decrease?
• Increase?
Inhibitory

9. Pharmacophysiology

10. Preferred AEDs

11. Status Epilepticus

13. Surgical options

14. Is routine blood levels of AEDs
warranted?

15. Perioperative considerations:
 Adherance to the anti-epile

16. Inhalational agents
 Nitrous oxide:
Proconvulsant in animal models.
Increases epileptiform activity intra
operatively.
Myoclonus observed in humans at
hyperbaric conditions.

17.  Sevofurane:
proconvulsant in paediatric age groups.
Widespread epileptiform activity in
EEG.
Isoflurane and desflurane:
Anticonvulsant property.
Have been used in status epilepticus.

18. Opioids
 Proconvulsant properties.
 Pethidine :
associated with myoclonus
and GTCS.
 Tramadol
 Alfentanil, sufentanil, remifentanil

19. IV induction agents
 Proconvulsant at low doses.
 Anticonvulsant at higher doses.
 Thiopentone and other barbiturates –
anticonvulsant
 Propofol-anticonvulsant.Incidences of
myoclonus and opisthotonus have
been reported.

20.  Etomidate –epileptogenic
 Ketamine –increases EEG spikes.
have been used in SE.
Metohexital-epileptogenic

21. Skeletal muscle relaxants
 Suxamethonium : contra indictaed in
SE.
 Increased risk of rhabdomyolysis and
hyperkalemia.
 Atracurium and cisatracurium:
Laudonosine metabolite has
epileptogenic potential.
 AED being enzyme inducers:
decreases the potency of NDMR.

22.  SMR masks seizures intraoperatively.
 How to diagnose?

23. Local anaesthetics:
 Lignocaine toxicity can cause seizures