Unexpected postoperative seizure after mastoid surgery. A case report

ABSTRACT

Postoperative seizures [expected after neurosurgery] are rare events. When they do occur, they are usually attributable to an identifiable drug reaction, a metabolic or neurological event. We report a case of postoperative seizure in postanesthesia care unit. A 19-yr-old female, 48 kg, was admitted to a hospital for left middle-ear surgery. Her medical history, physical examination and laboratory evaluation were normal. Anesthesia was induced with fentanyl 1 micro g/kg, thiopental 5 mg/kg and rocuronium 0.5 mg/kg to produce neuromuscular blockade. Anesthesia was initially maintained with oxygen, nitrous oxide and sevoflurane. Mastoid surgery was completed in 195 minutes after induction. The patient was extubated, but approximately 10 minutes after arrival in recovery she started to generalized tonic clonic convulsion. Oxygen was administered by face mask and thiopental 100 mg was administered intravenously. Blood sugar, electrolytes and body temperature were normal. After ten minutes convulsion episode was repeated. Because of the continuing seizure activity in a patient at risk of pulmonary aspiration and security of air way, her trachea was intubated by using thiopental and succinylcholine and ventilation controlled artificially. The seizures were controlled with midazolam and phenytoin. Computerized tomography [CT] showed left temporal cortical suspected hipodensity [Fig. 1] and the patient was transferred to ICU