Korean J Anesthesiol.  1994 Jun;27(6):649-654. 10.4097/kjae.1994.27.6.649.

Postoperative Idiopathic Generalized Convulsion Conversed to Generalized Status Epilepticus Following Spinal Anesthesia

• Lee HW
• Chang SH

• KMID: 2298875
• DOI: http://doi.org/10.4097/kjae.1994.27.6.649

Abstract

Generalized tonic-clonic convulsion was noted immediately after arriving at recovery room in eighteen year-old female patient who underwent an uneventful knee joint arthroscopy with spinal anesthesia. The first attack was successfully controlled with immediate treatment such as airway insertion, oxygenation and ventilation with mask, and infusion of 100 mg thiopental and 5 mg diazepam. The seizure activity changed to generalized status epilepticus after several recurrences of generalized convulsion, which was hard to control. The seizure activity was controlled by loading dose and continuous infusion of thiopental (total 1750 mg) and dilantin (total 1500 mg). A thorough diagnostic evaluation including a detailed medical investigation, neurologic physical examination, laboratory investigation with particular reference to blood chemistry test, computed tomogram, and magnetic resonance image except past history and electroencephalography (EEG) showed no abnormal findings. The patient has the past history of several attacks of idiopathic generalized convulsion in five or six year-old age and she showed generalized slow wave in EEG. No definite precipitating factor could be found in this case. But it may be vaguely suspected that the emotional stress of awakening state during operation under spinal anesthesia could have precipitated asymtomatic underlying seizure activity especially in the adolescent period even though the patient had clinically insignificant history of seizure attack.

Keyword

Idiopathic generalized convulsion; Status epilepticus; Spinal anesthesia

MeSH Terms

Adolescent
Anesthesia, Spinal*
Arthroscopy
Chemistry
Diazepam
Electroencephalography
Female
Humans
Knee Joint
Masks
Oxygen
Phenytoin
Physical Examination
Precipitating Factors
Recovery Room
Recurrence
Seizures*
Status Epilepticus*
Stress, Psychological
Thiopental
Ventilation
Diazepam
Oxygen
Phenytoin
Thiopental