6.1
Neurologic Disease
Epilepsy
- Etiology/Risk Factors
- Genetic
- Structural
- Trauma
- Ischemia
- Hemorrhage
- Metabolic
- Febrile
- 3–5% of children will have a febrile seizure before age 5
- 30% of those will have additional febrile seizures
- ↑ Risk of developing epilepsy
- Febrile
- Infection
- Immature brain (Neonates and infants) more prone to seizures
- Pathophysiology
- Abnormal, excessive, or synchronous discharge of neurons
- Intermittent and usually self‐limiting
- Provoked
- Identifiable systemic illness or brain insult
- Unprovoked (Figure 6.1)
- Unknown etiology
- Preexisting brain lesion or progressive nervous system disorder
- Status epilepticus
- Prolonged or recurrent without return of consciousness
- Abnormal, excessive, or synchronous discharge of neurons
- Treatment
- Avoid seizure triggers
- Antiepileptics
- Vagal nerve stimulator
- Focal resection
- Primary Concerns
- Perioperative seizure
- The presence of developmental delay may make cooperation difficult
- Medication interactions
- Anesthetics
- Oral contraception
- Liver function
- Coagulopathy
- Electrolyte abnormalities
- Evaluation
- Consider neurologist consultation
- CBC
- LFT
- BMP
- Careful history
- Type of seizure (Figure 6.1)
- Typical presentation
- Last seizure
- How often they occur
- How long they last
- Identifiable triggers
- Recognizable “aura”
- Self‐resolving vs. need for intervention
- Hospitalizations
- Anesthesia Management
- Consider premedication for uncooperative patient
- Continue antiepileptics perioperatively
- Avoid seizure triggers
- Most anesthetics have antiseizure activity
- Consider avoiding cisatracurium as its metabolite, laudanosine, is a proconvulsant
- Ketamine is now considered safe to use in epileptic patients [1]
- Seizure management covered on page 268
Neurofibromatosis Type 1
- Etiology/Risk Factors
- Autosomal dominant
- Pathophysiology (Figure 6.2)
- Café‐au‐lait macules
- Diffuse, benign, cutaneous neurofibromas which can interfere with physiologic functions and cause cosmetic problems
- ↑ Incidence of CHD
- ↑ Incidence of essential HTN
- Treatment
- Antiepileptics
- Removal of tumors interfering with function and/or esthetics
- Primary Concerns
- The presence of developmental delay may make cooperation difficult
- Chronic pain
- Neurofibromas
- Airway obstruction and difficult intubation
- Compress spinal nerves
- Presence of pheochromocytoma
- ↑ risk of seizures
- Evaluation
- Often cared for by multidisciplinary team
- Consider neurologist consultation
- Consider endocrinologist consultation
- Neurofibromas in airway
- Past airway/endoscopy notes
- Stridor
- Direct visualization in the mouth
- Consider oral intubation
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