Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(02): 110-114
DOI: 10.4103/2348-0548.182345
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Perioperative anaesthetic concerns during paediatric epilepsy surgeries: A retrospective chart review

Veena Sheshadri
Department of Anaesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
,
Seetharam Raghavendra
1   Department of Neurology, Vikram Hospitals, Bengaluru, Karnataka, India
,
B. A. Chandramouli
2   Department of Neurosurgery, Vikram Hospitals, Bengaluru, Karnataka, India
› Author Affiliations
Further Information

Publication History

Publication Date:
03 May 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background: Epilepsy in children is a common medical condition which usually responds well to antiepileptic drugs (AEDs). Surgical intervention is required in 30-40% of patients for refractory epilepsy. Paediatric patients present challenges to neurosurgeons as well as anaesthesiologists in view of the inherent physiological and developmental differences. We aimed to analyse the key perioperative factors affecting the paediatric epilepsy surgeries as well as the intraoperative and intensive care unit (ICU) complications and safety of the procedure in children. Materials and Methods: We performed a retrospective chart review of perioperative data of 39 patients who underwent surgery for refractory epilepsy. Results: The surgical procedures were either resective or disconnective. The fraction of blood volume lost intraoperatively correlated well with the duration of surgery (P < 0.001, r =0.76). In the postoperative course in ICU, 7 children required postoperative ventilation and 14 developed fever, which was significantly more (P < 0.001) after disconnective surgeries. Conclusions: The blood loss and delayed recovery were found to be the main anaesthetic concerns perioperatively, especially with disconnective surgeries. The choice of anaesthetic agents did not affect electrocorticography or the course of surgery. Neurological complications and fever of non-infectious aetiology must be considered in the postoperative period in ICU. Paediatric epilepsy surgery can be safe and feasible with multidisciplinary team approach.

Keywords

Paediatric anaesthesia - paediatric epilepsy surgery - refractory epilepsy
 

  • REFERENCES

  • 1 Koh JL, Egan B, McGraw T. Pediatric epilepsy surgery: Anesthetic considerations. Anesthesiol Clin 2012; 30: 191-206
    CrossrefPubMedSearch in Google Scholar
  • 2 Schramm J, Clusmann H. The surgery of epilepsy. Neurosurgery 2008; 62 Suppl (Suppl. 02) 463-81
    CrossrefPubMedSearch in Google Scholar
  • 3 Dorfmüller G, Delalande O. Pediatric epilepsy surgery. Handb Clin Neurol 2013; 111: 785-95
    PubMedSearch in Google Scholar
  • 4 Kunieda T, Kikuchi T, Miyamoto S. Epilepsy surgery: Surgical aspects. Curr Opin Anaesthesiol 2012; 25: 533-9
    CrossrefPubMedSearch in Google Scholar
  • 5 Harvey AS, Cross JH, Shinnar S, Mathern GW. ILAE Pediatric Epilepsy Surgery Survey Taskforce. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 2008; 49: 146-55
    CrossrefPubMedSearch in Google Scholar
  • 6 Soriano SG, Bozza P. Anesthesia for epilepsy surgery in children. Childs Nerv Syst 2006; 22: 834-43
    CrossrefPubMedSearch in Google Scholar
  • 7 Pietrini D, Zanghi F, Pusateri A, Tosi F, Pulitanò S, Piastra M. Anesthesiological and intensive care considerations in children undergoing extensive cerebral excision procedure for congenital epileptogenic lesions. Childs Nerv Syst 2006; 22: 844-51
    CrossrefPubMedSearch in Google Scholar
  • 8 Soriano SG, Eldredge EA, Rockoff MA. Pediatric neuroanesthesia. Neuroimaging Clin N Am 2007; 17: 259-67
    CrossrefPubMedSearch in Google Scholar
  • 9 Thudium MO, von Lehe M, Wessling C, Schoene-Bake JC, Soehle M. Safety, feasibility and complications during resective pediatric epilepsy surgery: A retrospective analysis. BMC Anesthesiol 2014; 14: 71
    CrossrefPubMedSearch in Google Scholar
  • 10 Constant I, Dubois MC, Piat V, Moutard ML, McCue M, Murat I. Changes in electroencephalogram and autonomic cardiovascular activity during induction of anesthesia with sevoflurane compared with halothane in children. Anesthesiology 1999; 91: 1604-15
    CrossrefPubMedSearch in Google Scholar
  • 11 Constant I, Seeman R, Murat I. Sevoflurane and epileptiform EEG changes. Paediatr Anaesth 2005; 15: 266-74
    CrossrefPubMedSearch in Google Scholar
  • 12 Vakkuri A, Yli-Hankala A, Särkelä M, Lindgren L, Mennander S, Korttila K. et al. Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children. Acta Anaesthesiol Scand 2001; 45: 805-11
    CrossrefPubMedSearch in Google Scholar
  • 13 Todd MM, Warner DS, Sokoll MD, Maktabi MA, Hindman BJ, Scamman FL. et al. A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 1993; 78: 1005-20
    CrossrefPubMedSearch in Google Scholar
  • 14 Soriano SG, Eldredge EA, Rockoff MA. Pediatric neuroanesthesia. Anesthesiol Clin North America 2002; 20: 389-404
    CrossrefPubMedSearch in Google Scholar
  • 15 Carson BS, Javedan SP, Freeman JM, Vining EP, Zuckerberg AL, Lauer JA. et al. Hemispherectomy: A hemidecortication approach and review of 52 cases. J Neurosurg 1996; 84: 903-11
    CrossrefPubMedSearch in Google Scholar
  • 16 Griffiths PD, Welch RJ, Gardner-Medwin D, Gholkar A, McAllister V. The radiological features of hemimegalencephaly including three cases associated with proteus syndrome. Neuropediatrics 1994; 25: 140-4
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Peacock WJ, Wehby-Grant MC, Shields WD, Shewmon DA, Chugani HT, Sankar R. et al. Hemispherectomy for intractable seizures in children: A report of 58 cases. Childs Nerv Syst 1996; 12: 376-84
    CrossrefPubMedSearch in Google Scholar
  • 18 Taha JM, Crone KR, Berger TS. The role of hemispherectomy in the treatment of holohemispheric hemimegaloencephaly. J Neurosurg 1994; 81: 37-42
    CrossrefPubMedSearch in Google Scholar
  • 19 Vining EP, Freeman JM, Pillas DJ, Uematsu S, Carson BS, Brandt J. et al. Why would you remove half a brain?. The outcome of 58 children after hemispherectomy-the Johns Hopkins experience: 1968 to 1996. Pediatrics 1997; 100 (2 Pt 1) 163-71
    CrossrefPubMedSearch in Google Scholar
  • 20 Finsterer J, Pelzl G, Hess B. Severe, isolated thrombocytopenia under polytherapy with carbamazepine and valproate. Psychiatry Clin Neurosci 2001; 55: 423-6
    CrossrefPubMedSearch in Google Scholar
  • 21 Holtzer CD, Reisner-Keller LA. Phenytoin-induced thrombocytopenia. Ann Pharmacother 1997; 31: 435-7
    CrossrefPubMedSearch in Google Scholar
  • 22 Gerstner T, Teich M, Bell N, Longin E, Dempfle CE, Brand J. et al. Valproate-associated coagulopathies are frequent and variable in children. Epilepsia 2006; 47: 1136-43
    CrossrefPubMedSearch in Google Scholar
  • 23 Manohar C, Avitsian R, Lozano S, Gonzalez-Martinez J, Cata JP. The effect of antiepileptic drugs on coagulation and bleeding in the perioperative period of epilepsy surgery: The Cleveland clinic experience. J Clin Neurosci 2011; 18: 1180-4
    CrossrefPubMedSearch in Google Scholar
  • 24 de Almeida AN, Marino Jr. R, Aguiar PH, Teixeira MJ. Postoperative fever after hemispherectomy: The role of non-infectious factors. Seizure 2006; 15: 340-3
    CrossrefPubMedSearch in Google Scholar
  • 25 Phung J, Mathern GW, Krogstad P. Timing and predictors of fever and infection after craniotomy for epilepsy in children. Pediatr Infect Dis J 2013; 32: 450-9
    CrossrefPubMedSearch in Google Scholar
  • 26 de Almeida AN, Marino Jr. R, Marie SK, Aguiar PH, Teixeira MJ. Factors of morbidity in hemispherectomies: Surgical technique x pathology. Brain Dev 2006; 28: 215-22
    CrossrefPubMedSearch in Google Scholar
  • 27 Garibaldi RA, Brodine S, Matsumiya S, Coleman M. Evidence for the non-infectious etiology of early postoperative fever. Infect Control 1985; 6: 273-7
    CrossrefPubMedSearch in Google Scholar
  • 28 Schwarz S, Häfner K, Aschoff A, Schwab S. Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology 2000; 54: 354-61
    CrossrefPubMedSearch in Google Scholar