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

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

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