DD SEIZURE PERIOP

1. Post op Seizure
By
Dr. AHMED ABDELRAHMAN
Lecturer of anesthesia and intensive
care

3. OBJECTIVES
1. Definition of seizure
2. Classification
3. Causes of post op seizures
4. Management

4. Definition
Seizure : means a convulsion or other
transient event caused by a paroxysmal
discharge of cerebral neurons.

5. Classification
 Generalized :
Means bilateral abnormal electrical activity,
with bilateral motor manifestations and
impaired consciousness.

6.  Partial seizure:
Means that the electrical activity is localized to
one part of the brain;
1. Simple - without loss of consciousness,
e.g. one limb jerking.
2. Complex – with loss of awareness , e.g.
temporal lobe attack.

7.  Status epilepticus :
 Any seizure lasting more than 5 minutes is
considered status epilepticus.
 Mortality is between 5% to 30% because of
hypoxia, hyperpyrexia and hypotension.
 Aggressive prompt intervention is the key of
survival.

8. Causes
 Epilepsy
 Acute CNS lesion
Cerebrovascular accidents ( ischemic stroke, ICH,
SAH),
Traumatic brain injury
Global hypoxic – ischemic brain injury
Encephalitis and Meningitis
 Chronic CNS lesions
Existing stroke - Brain tumor

9.  Toxic and Metabolic derangement :
Hypoglycemia
Drug withdrawal (
alcohol,benzodiazepines)
Electrolytes ( NA , Mg, Ca ,K)
Iatrogenic: medications e.g. B-
lactamases,
Thyophylline.
Febrile convulsions in young children
 Local anesthetic toxicity.
 Post-partum Eclampsia.

10. Management
 General measures:
1. Assess and protect airway
2. Monitor vital signs
3. Check bedside glucose level
4. Obtain IV access
5. Send lab
 Specific TTT.

11. Initial anticonvulsant
TTT
1. Lorazepam 4mg IV repeat 2-4 mg every
2-3 min to a max of 0.01 mg /kg.
2. Phenytoin or fosphenytoin loading of 18-
20 mg/kg, Max rate of infusion 50 mg/
min. phenytoin and 150 mg/ min
fosphenytoin.
3. Consider giving thiamine 100 mg Iv with
glucose ( 50 ml of D50).

12. If seizure continue :
 Additional 10- 20 mg IV phenytoin.
 Consider second line agents:
1. Valproate 20 – 40 mg IV bolus over 10
min,
2. levetiracetam 2 gm. IV bolus.
3. Phenobarbital 5 mg /kg to a max of 20
mg/ kg give q 15 min.
 Consider intubation in case of hypoxia or
aspiration.

13.  Convulsive seizure stop:
 Check phenytoin level every 1-2 hr post
load.
 Perform additional diagnostic studies .e.g.
CT scan lumbar puncture.
 Consider EEG monitoring for non
convulsive seizure.

14. Persistent seizure activity:
 General management
1. Intubate for airway protection.
2. Continue EEG monitoring.
3. Close hemodynamic monitor.
4. Continue maintenance AEDs.
5. TTT of underlying cause.
6. Neurology consultation.

15.  Seizure control
1. Initiate infusion to control clinical and
electrographic seizure.
2. Can give loading bolus of the same
agent.
3. Titrate infusion to maintain seizure
control,
4. If not controlled consider alternate agent
with goal of inducing Burst suppression.
5. Finally consider therapeutic hypothermia.

16.  Seizure controlled:
1. Continue infusion for 24 hr at rate that
achieved target.
2. Monitor closely for complication of TTT
.e.g. ileus, hemodynamic instability,
infections.
3. After 24 hr try to gradually wean infusion
off and watch for recurrent seizure.

17. Specific management
 Electrolyte disturbances -------- Correction
 Post-partum eclampsia --------- Mg sulphate
 Local anesthetic toxicity --------lipid
emulsion (20%)
 Febrile convulsion ---------------- cooling