Anaesthesia and the epileptic pateint. A review

Preoperative management of the surgical patient with neurologic disease

This article reviews neurologic problems that have been categorized into two groups: parenchymal and vascular disease. Each disease has a brief summary of key clinical points, followed by recommended management strategies. The neurologic diseases most frequently encountered by the medical consultant are presented.

Diet induced ketosis in epilepsy and anaesthesia. Metabolic changes in three patients on a ketogenic diet

Ketogenic diets have a high fat and low carbohydrate and low protein content to induce ketosis which is monitored by daily urine testing. Lapses in diet are frequently associated with loss of anticonvulsant control. There has, as yet, been no report of children maintained on a ketogenic diet subject to anaesthesia and surgery: this paper records the changes in metabolic variables observed in three patients undergoing simple inhalation anaesthetics for minor surgery.

Postoperative convulsions due to iophendylate (Myodil). Report of a case and review of the causes of postoperative convulsions

A previously fit 58-year-old man underwent lumbar laminectomy following a myelogram. Postoperatively convulsions occurred. He was successfully treated and made a complete recovery. Large quantities of intracranial iophendylate (Myodil) were seen on postoperative skull X-rays. In the absence of other likely causes, a diagnosis of iophendylate-induced encephalopathy was made. A review of the aetiology of convulsions in the intra- and postoperative period is presented.

The influence of intravenous anaesthetics on enflurane-induced central nervous system seizure activity

This study assesses the effects of agents commonly used in anaesthesia on enflurane-induced seizure threshold and on established seizure activity, during steady state enflurane anaesthesia. EEG seizure activity was monitored in cats from chronic cortical and subcortical recording sites. Diazepam, thiopentone, methohexitone and ketamine all enhanced established EEG seizure challenge. This latter effect was most evident under conditions of lowered PaCO2. The effects of these intravenous agents on established enflurane seizure patterns exceeded in duration the expected EEG effect of the agent when used alone. The limited number of experiments, however, precluded statistical verification of our findings. The similarities between centrencephalic minor motor seizures and enflurane seizure pattern in terms of EEG and convulsive expression, including drug response, are noted.

Etomidate, a new water-soluble non-barbiturate intravenous induction agent

This paper describes clinical experimence, in 100 patients, with the new non-barbiturate, water soluble induction agent, etomidate. This drug produces sleep in one arm/brain circulation-time. There was no effect on pulse-rate, a slight fall in blood-pressure, and a low frequency of apnoea. Involuntary movements were noted, and in some patients these were severe. Etomidate warrants further evaluation as an intravenous induction agent.