Patient With Neurological Disorders Suffers From Seizures Post-Anesthesia

Case Overview

This case involves a 12-year-old paraplegic boy with spinal column malformation. After an extended hospital stay, the patient required surgery for a pressure sore. On the day of the surgery, the patient was given less than half his normal dosage of Levetiracetam. Before the surgery, the surgeon decided to limit the patient’s placement in unnatural positions. During the procedure, however, the patient was placed in the jackknife position. Postoperatively, the CRNA noted that there was a great deal of head swelling. The patient subsequently developed severe neurologic symptoms, including seizures, resulting in a stroke that damaged part of the patient’s brainstem. It was suggested that the patient’s head was down for too long a period of time. It was further alleged that the patient was insufficiently monitored during the procedure in spite of the high risk of the patient experiencing seizure activity following the operation.

Questions to the Anesthesiology expert and their responses

How often do you perform anesthesia on patients with a past medical history of severe neurological disorders?

I do cases about once a week that involves patients with severe neurological deficits.

In general, what aspects of the positioning of the patient are important in preventing neurologic sequelae in patients with severe neurological disorders?

The positioning of a patient with severe neurologic deficits is important to consider because of unexpected and unknown changes from the norm. I would look at the nurse's notes preoperatively and intraoperatively to verify what is written by the anesthesia providers.

What type of intraoperative neurological monitoring is important in patients like this undergoing general anesthesia?

Qualitative visual monitoring is important to make sure common areas of injury are monitored. Certain types of surgery would determine if quantitative neurologic monitoring is required. For instance, neurosurgical cases where neurologic damage is a possibility usually has evoked potential monitoring. In some general anesthesia cases, a BIS monitor is used to determine the depth of anesthesia. In other cases, cerebral pulse oximetry is used.

About the expert

This expert has more than 25 years of clinical experience as a board certified anesthesiologist. He earned his MD from Loyola Stritch School of Medicine following a BS in biochemistry from the University of California, Riverside. He completed residencies in general surgery and anesthesiology at Loma Linda University Medical Center and is a member of the American Society of Regional Anesthesia and Pain Medicine. He previously served as a staff anesthesiologist at Lakewood Medical Center and Citrus Valley Medical Center, as Medical Director at the Center for Aesthetic Surgery, and as the Vice-Chairman of anesthesia at Alhambra Hospital. Currently, he serves as the CEO of a pharmaceutical startup and the chief of anesthesia at a hospital in the Los Angeles area.