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Perioperative care of the surgical patient with neurologic disease

Authors
Geno J Merli, MD, FACP, FHM
Rodney D Bell, MD
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editors
Janet L Wilterdink, MD
Marianna Crowley, MD

INTRODUCTION

Perioperative care of the patient with neurologic disease is a challenge for the medical consultant. The most important considerations are the management of medications used to treat neurologic disorders, an understanding of the pathophysiologic mechanism of these disorders, and evaluation of new neurologic changes that occur perioperatively. The more commonly encountered neurologic disorders and their perioperative management are reviewed here.

SEIZURE DISORDERS

At least one million people in the United States have recurrent seizures or epilepsy [1]. Most patients with epilepsy are managed with antiepileptic drugs (AEDs). (See "Overview of the management of epilepsy in adults".)

People with epilepsy appear to be at significant risk of postoperative complications, some of which are attributed to epilepsy and some to comorbidities associated with epilepsy. In one retrospective database study, 13,103 patients with epilepsy had a higher rate of postoperative complications compared to those without epilepsy (OR = 2) [2]. Stroke was identified as the most significant postoperative complication in patients with epilepsy.

Causes of seizures in perioperative patients — Seizures can occur during the perioperative period due to a number of causes:

Anesthesia

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 10 00:00:00 GMT+00:00 2014.
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