Epilepside Perioperatif Yönetim ve Anestezi

Epilepsi paroksismal, tekrarlayıcı nöbetlerle seyreden klinik bir hastalık olup popülasyonun önemli oranını etkiler; böylelikle epilepsili hastalar anestezi uygulamalarının önemli bir bileşenini oluşturmaktadır. Antiepileptik ajanların anestezi üzerine etkisi olabilecek birçok fizyolojik ve farmakolojik etkisi mevcuttur; bunun yanı sıra anestezik ajanların kendilerinin de nöbet aktivitesini modüle etme veya güçlendirme kapasitesi vardır. Bu derlemede epilepsili olguların perioperatif yönetiminde izlenecek planı; ayrıca güncel epilepsi cerrahisine özgü anestezik yaklaşımı ortaya koymayı amaçladık.

Perioperative Management and Anesthesia in Epilepsy

Epilepsi paroksismal, tekrarlayıcı nöbetlerle seyreden klinik bir hastalık olup popülasyonun önemli oranını etkiler; böylelikle epilepsili hastalar anestezi uygulamalarının önemli bir bileşenini oluşturmaktadır. Antiepileptik ajanların anestezi üzerine etkisi olabilecek birçok fizyolojik ve farmakolojik etkisi mevcuttur; bunun yanı sıra anestezik ajanların kendilerinin de nöbet aktivitesini modüle etme veya güçlendirme kapasitesi vardır. Bu derlemede epilepsili olguların perioperatif yönetiminde izlenecek planı; ayrıca güncel epilepsi cerrahisine özgü anestezik yaklaşımı ortaya koymayı amaçladık.

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  • Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48-55.
  • Shafique S, Dalsing MC. Vagus nerve stimulation therapy for treatment of drug-resistant epilepsy and depression. Perspect Vasc Surg Endovasc Ther. 2006;18:323-7.
  • Tatum WO, Moore DB, Stecker MM, Baltuch GH, French JH, Ferreria JA et al. Ventricular asystole during vagus nerve stimulation for epilepsy in humans. Neurology. 1999;52:1267-9.
  • Hatton KW, McLarney JT, Pittman T, Fahy BG. Vagal nerve stimulation: overview and implications for anesthesiologists. Anesth Analg. 2006;103:1241-9.
  • Koo B. EEG changes with vagus nerve stimulation. J Clin Neurophysiol. 2001;18:434-41.
  • Vonck K, De Herdt V, Bosman T, Dedeurwaerdere S, Van Laere K, Boon P. Thalamic and limbic involvement in the mechanism of action of vagus nerve stimulation, a SPECT study. Seizure. 2008;17:699-706.
  • Henry TR, Bakay RAE, Pennell PB, Epstein CM, Votaw JR. Brain blood-flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: II. Prolonged effects at high and low levels of stimulation. Epilepsia. 2004;45:1064-70.
  • Hammond EJ, Uthman BM, Wilder BJ, Benmenachem E, Hamberger A, Hedner T et al. Neurochemical effects of vagus nerve stimulation in humans. Brain Res. 1992;583:300-3.
  • Marrosu F, Serra A, Maleci A, Puligheddu M, Biggio G, Piga M. Correlation between GABA(A) receptor density and vagus nerve stimulation in individuals with drug-resistant partial epilepsy. Epilepsy Res. 2003;55:59-70.
  • Benmenachem E, Hamberger A, Hedner T, Hammond EJ, Uthman BM, Slater J et al. Effects of Vagus Nerve-Stimulation on Amino-Acids and Other Metabolites in the Csf of Patients With Partial Seizures. Epilepsy Res. 1995;20:221-7.
  • Woodbury DM, Woodbury JW. Effects of vagal stimulation on experimentally induced seizures in rats. Epilepsia. 1990;31:7-1
  • Krahl SE, Clark KB, Smith DC, Browning RA. Locus coeruleus lesions suppress the seizure-attenuating effects of vagus nerve stimulation. Epilepsia. 1998;39:709-14.
  • Hassert DL, Miyashita T, Williams CL. The effects of peripheral vagal nerve stimulation at a memory-modulating intensity on norepinephrine output in the basolateral amygdala. Behav Neurosci. 2004;118:79-88.
  • Roosevelt RW, Smith DC, Clough RW, Jensen RA, Browning RA. Increased extracellular concentrations of norepinephrine in cortex and hippocampus following vagus nerve stimulation inthe rat. Brain Res. 2006;1119:124-32.
  • Ramsay RE, Uthman BM, Augustinsson LE, et al. Vagus nerve stimulation for treatment of partial seizures: safety, side effects, and tolerability. Epilepsia 1994;35:627–36.
  • Balki M, Manninen PH, McGuire GP, El-Beheiry H, Bernstein M. Venous air embolism during awake craniotomy in a supine patient. Can J Anaesth. 2003;50:835-8.
  • Lobo F, Beiras A. Propofol and remifentanil effect-site concentrations estimated by pharmacokinetic simulation and bispectral index monitoring during craniotomy with intraoperative awakening for brain tumor resection. J Neurosurg Anesthesiol. 2007;19:183-9.
  • Souter MJ, Rozet I, Ojemann JG, Souter KJ, Holmes MD, Lee L et al. Dexmedetomidine sedation during awake craniotomy for seizure resection: Effects on electrocorticography. J Neurosurg Anesth. 2007;19:38-44
  • Manninen PH, Balki M, Lukitto K, Bernstein M. Patient satisfaction with awake craniotomy for tumor surgery: A comparison of remifentanil and fentanyl in conjunction with propofol. Anesth Analg. 2006;102:237-42
  • Gignac E, Manninen PH, Gelb AW. Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy. Can J Anaesth. 1993;40:421-4.
  • Hans P, Bonhomme V. Why we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia. Curr Opin Anaesthesiol. 2006;19:498-503.
  • Chakrabarti R, Tewari A, Sinha A, Ghazanwy M. Awake craniotomy: A qualitative review and future challenges. Saudi J Anaesth. 2014; 8:529-39.
  • Hansen E, Seemann M, Zech N, Doenitz C, Luerding R, Brawanski A. Awake craniotomies without any sedation: The awake-awake-awake technique. Acta Neurochir (Wien). 2013;155:1417-24.
  • Olsen KS. The asleep-awake technique using propofol-remifentanil anaesthesia for awake craniotomy for cerebral tumours. Eur J Anaesthesiol. 2008;25:662-9.
  • Costello TG, Cormck JR, Mather LE, LaFerlita B, Murphy MA, Harris K. Plasma levobupivacaine levels following scalp block in patients undergoing awake craniotomy. Br J Anaesth. 2005;94:848-51
  • Costello TG, Cormack JR, Hoy C, Wyss A, Braniff V, Martin K et al. Plasma ropivacaine levels following scalp block for awake craniotomy. J Neurosurg Anesthesiol. 2004;16:147-50.
  • Costello TG, Cormack JR. Anaesthesia for awake craniotomy: a modern approach, J Clin Neurosci. 2004;11:16-9.
  • Osborn I, Sebeo J. “Scalp block” during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 2010;22:187-94
  • Matsunami K, Sanuki M, Yasuuji M, Nakanuno R, Kato T, Kawamoto M. Successful airway management using i-gel in 7 patients undergoing awake craniotomy. Masui. 2014;63:789-93.
  • Piccioni F, Fanzio M. Management of anesthesia in awake craniotomy. Minerva Anestesiol. 2008;74:393-408.
  • Gadhinglajkar S, Sreedhar R, Abraham M. Anesthesia management of awake craniotomy performed under asleep-awake-asleep technique using laryngeal mask airway: report of two cases. Neurol India. 2008;56:65-7.
  • Huncke K, Van De Wiele B, Fried I, Rubinstein EH. The asleep-awake-asleep anesthetic technique for intraoperative language mapping. Neurosurgery. 1998;42:1312-7.
  • Herrick IA, Gelb AW. Anesthesia for temporal lobe epilepsy surgery. Can J Neurol Sci. 2000;27:64-7.
  • Manninen PH, See J.J. Epilepsy, epilepsy surgery, awake craniotomy for tumor surgery, and intraoperative magnetic resonance imaging. In: Handbook of Neuroanesthesia. 4th ed (Eds Newfield P, Cottrell JE),:198-215. USA, Lippincott Williams and Wilkins. 2007
  • Erickson KM, Cole DJ. Anesthetic Considerations for Awake Craniotomy for Epilepsy and Functional Neurosurgery. Anesthesiol Clin. 2012;30:241-68.
  • Herrick IA, Craen RA, Gelb AW, McLachlan RS, Girvin JP, Parrent AG et al. Propofol sedation during awake craniotomy for seizures: electrocorticographic and epileptogenic effects. Anesth Analg. 1997;84:1280-4.
  • Wolfson R, Soni N, Shah AH, Hosein K, Sastry A, Bregy A et al. The role of awake craniotomy in reducing intraoperative visual field deficits during tumor surgery. Asian J Neurosurg. 2015;10:139-44.
  • Reasoner DK, Todd MM, Scamman FL,Warner DS. The incidence of pneumocephalus after Supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology. 1994;80:1008-12.
  • Chui J. Anesthesia for awake craniotomy: An update. Colomb J Anesthesiol. 2015;43:22-8
  • Morgan E, Mikhail MS, Murray MJ. Clinical Anaesthesiology. 5th ed. New York, McGraw-Hill. 2002.
  • Tuxbury AF, Ruskin KJ. (2003, March). Anesthetic implications of surgery for seizure disorders. In Seminars in Anesthesia. Perioperative Medicine and Pain. 2003;22:33-42
  • Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: A systematic review. Epilepsia. 2002;43:146-53
  • Parviainen I, Uusaro A, Kalviainen R, Kaukanen E, Mervaala E, Ruokonen E. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology. 2002;59:1249-51.
  • Holtkamp M. The anaesthetic and intensive care of status epilepticus. Curr Opin Neurol. 2007;20:188-93.
  • Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia. 1993; 34:54-8.
  • Kopp SL, Wynd KP, Horlocker TT, Hebl JR, Wilson JL. Regional blockade in patients with a history of a seizure disorder. Anesth Analg. 2009;109:272-8.
  • Melton AT, Antognini JE, Gronert GA. Prolonged duration of succinylcholine in patients receiving anticonvulsants: evidence for mild up-regulation of acetylcholine receptors? Can J Anaesth. 1993;40:939-42.
  • Spacek A, Nickl S, Neiger FX, Nigrovic V, Ullrich OW, Weindmayr-Goettel M et al. Augmentation of the rocuronium-induced neuromuscular block by the acutely administered phenytoin.Anesthesiology. 1999;90:1551-5.
  • Hoffman WE, Edelman G. Comparison of isoflurane and desflurane anesthetic depth using burst suppression of the electroencephalogram in neurosurgical patients. Anesth Analg. 1995;81:811-6.
  • Sharpe MD, Young GB, Mirsattari S, Harris C. Prolonged desflurane administration for refractory status epilepticus. Anesthesiology. 2002;97:261–4.
  • Iijima T, Nakamura Z, Iwao Y, Sankawa H. The Epileptogenic Properties of the Volatile Anesthetics Sevoflurane and Isoflurane in Patients with Epilepsy. Anesth Analg. 2000;91:989-95.
  • Kaisti KK, Jaaskelainen SK, Rinne JO, Metsahonkala L, Scheinin H: Epileptiform discharges during 2 MAC sevoflurane anesthesia in two healthy volunteers. Anesthesiology. 1999;91:1952-5.
  • Vakkuri A, Yli-Hankala A, Särkelä M, et al. Sevoflurane mask induction of anaesthesia is associated with epileptiform EEG in children. Acta Anaesthesiol Scand. 2001;45:805-11
  • Scheller MS, Tateishi A, Drummond JC, Zornow MH. The effects of sevoflurane on cerebral blood flow, cerebral metabolic rate for oxygen, intracranial pressure, and the electroencephalogram are similar to those of isoflurane in the rabbit. Anesthesiology. 1988;68:548-51.
  • Zieglgänsberger W, French ED, Siggins GR, Bloom FE. Opioid peptides may excite hippocampal pyramidal neurons by inhibiting adjacent inhibitory interneurons. Science. 1979;205:415-7.
  • Akeson J, Didriksson I. Convulsions on anaesthetic induction with sevoflurane in young children. Acta Anaesthesiol Scand. 2004;48:405-7.
  • Constant I, Seeman R, Murat I. Sevoflurane and epileptiform EEG changes. Paediatr Anaesth. 2005;15:266-74.
  • Schubert A, Lotto M. Awake craniotomy epilepsy, minimally ınvasive and robotic surgery. In: Cottrell and Young's Neuroanesthesia, 5th ed (Eds Cottrell JE, Young WL):296-316 Philadelphia, Mosby Elsevier, 2010
  • Fiol ME, Boening JA, Cruz-Rodriguez R, Maxwell R. Effect of isoflurane (Forane) on intraoperative electrocorticogram. Epilepsia. 1993;34:897-900
  • Bindra A, Chouhan RS, Prabhakar H, Dash HH, Chandra PS, Tripathi M. Comparison of the effects of different anesthetic techniques on electrocorticography in patients undergoing epilepsy surgery e a bispectral index guided study. Seizure. 2012;21:501-7
  • Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004;61:1254-9.
  • Herrick IA, Craen RA, Blume WT, Novick T, Gelb AW. Sedative doses of remifentanil have minimal effect on ECoG spike activity during awake epilepsy surgery. J Neurosurg Anesthesiol. 2002;14:55-8.
  • Haber GW, Litman RS. Generalized Tonic-Clonic Activity After Remifentanil Administration. Anesth Analg. 2001;93:1532-3.
  • Hoffman WE, Cunningham F, James MK, Baughman VL, Albrecht RF. Effects of remifentanil, a new short-acting opioid, on cerebral blood flow, brain electrical activity, and intracranial pressure in dogs anesthetized with isoflurane and nitrous oxide. Anesthesiology. 1993;79:107-13
  • Zieglgänsberger W, French ED, Siggins GR, Bloom FE. Opioid peptides may excite hippocampal pyramidal neurons by inhibiting adjacent inhibitory interneurons. Science. 1979;205:415-7.
  • Siggins GR, Henriksen SJ, Chavkin C, Gruol D. Opioid peptides and epileptogenesis in the limbic system: cellular mechanisms. Adv Neurol. 1986;44:501-12.
  • Kofke WA, Garman RH, Tom WC, Rose ME, Hawkins RA. Alfentanil-induced hypermetabolism, seizure, and histopathology in rat brain. Anesth Analg. 1992;75:953-64.
  • Tommasino C, Maekawa T, Shapiro HM, Keifer-Goodman J, Kohlenberger RW. Fentanyl-induced seizures activate subcortical brain metabolism. Anesthesiology. 1984;60:283-90.
  • Young ML, Smith DS, Greenberg J, Reivich M, Harp JR. Effects of sufentanil on regional cerebral glucose utilization in rats. Anesthesiology. 1984;61:564-8.
  • Cascino GD, So EL, Sharbrough FW, Strelow D, Lagerlund TD, Milde LN et al. Alfentanil-induced epileptiform activity in patients with partial epilepsy. J Clin Neurophysiol. 1993;10:520-5.
  • Wass CT, Grady RE, Fessler AJ, Cascino GD, Lozada L, Benchtle PS et al. The effects of remifentanil on epileptiform discharges during ıntraoperative electrocorticography in patients undergoing epilepsy surgery. Epilepsia. 2001;42:1340-4.
  • Voss LJ, Sleigh JW, Barnard JP, Kirsch HE. The howling cortex: seizures and general anesthetic drugs. Anesth Analg. 2008;107:1689-1703.
  • Pedroviejo V, Ayuso M, Jiménez A. Tratamiento anestésico del paciente adulto epiléptico no neuroquirúrgico. Rev Esp Anestesiol Reanim. 2009;56:425-35.
  • Bhagat H, Dash HH. Anesthesiologist’s role in the management of an epileptic patient. Indian J Anaesth. 2006;50:20-6.
  • Ahmed SU, Vallejo R, Hord ED. Seizures after a Bier block with clonidine and lidocaine. Anesth Analg. 2004;99:593-4.
  • Sturaitis MK, Ford EW, Palac SM,. Smith MC, Tuman KJ: Effect of dexmedetomidine on operative conditions and electrocorticographic responses during asleep craniotomy for seizure focus resection. ASA Meeting Abstract number A- 290, 2003
  • Miyazaki Y, Adachi T, Kurata J, Utsumi J, Shichino T, Segawa H. Dexmedetomidine reduces seizure threshold during enflurane anaesthesia in cats. Br J Anaesth. 1999;82:935-7.
  • Parviainen I, Uusaro A, Kälviäinen R, Mervaala E, Ruokonen E. Propofol in the treatment of refractory status epilepticus. Intensive Care Med. 2006;32:1075-9
  • Wang B, Bai Q, Jiao X, Wang E, White PF. Effect of sedative and hypnotic doses of propofol on the EEG activity of patients with and without a history of seizure disorders. J Neurosurg Anesthesiol. 1997;9:335-40.
  • Hickey R. Effects ofNeuroanesthesia, 5th ed (Eds Newfield P, Cottrell JE): 23-35. New-York, Lippincott Williams and Wilkins. 2007 anesthesia on cerebral and spinal cord physiology. In: Handbook of
  • Modica PA, Tempelhoff R, White PF. Pro- and anticonvulsant effects of anesthetics. Anesth Analg. 1990;70:303-15.
  • Benish SM, Cascino GD, Warner ME, Worrell GA, Wass CT. Effect of general anesthesia in patients with epilepsy: a population-based study. Epilepsy Behav. 2010;17:87-9.
  • Valencia I, Pfeifer H, Thiele EA. General anesthesia and the ketogenic diet: Clinical experience in nine patients. Epilepsia. 2002;43:525-9.
  • Rizzutti S, Nishiyama AN, Muszkat M, Carlos CJR. Epilepsias-Tratamentos alternativos. Rev Neurociencias. 1999;7:32-8.
  • Bloor M, Nandi R, Thomas M. Antiepileptic drugs and anesthesia. Paediatr Anaesth. 2017;27:248-50.
  • Kofke WA. Anesthetic management of the patient with epilepsy or prior seizures. Curr Opin Anaesthesiol. 2010;23:391-9.
  • Shetty A, Pardeshi S, Shah VM, Kulkarni A. Anesthesia considerations in epilepsy surgery. Int J Surg. 2015;36:454-9.
  • American Epilepsy Society (AES) 2016 Annual Meeting. “Symposium: The New Definition and Classification of Epilepsy.” Presented. December 2, 2016
  • Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58:531-42.
  • Aminof MJ. Nervous System Disorders. In: Current Medical Diagnosis and Treatment.49th ed (Eds McPhee SJ, Papadakis MA):878-89. New York, McGraw Hill Lange. 2009
  • Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology. Epilepsia. 2010;51:676-85.
  • Commission on Classification and Terminology of the International League against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30:389-99.
  • Chin RFM, Neville BGR, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11:800-10.
  • Ren WHP. Anesthetic management of epileptic pediatric patients. Int Anesthesiol Clin. 2009;47:101-16.
  • Perks A, Cheema R, Mohanraj R. Anaesthesia and epilepsy. Br J Anaesth. 2012;108:562-71
  • Goldensohn ES. Historical Perspective. In: Epilepsy: a Comprehensive Textbook. 1st ed (Eds Engel Jr J, Pedley TA): 15-6. Philadelphia, Lippincott-Raven. 1997
  • Maranhão MVM, Gomes EA, de Carvalho PE. Epilepsy and Anesthesia. Rev Bras Anestesiol. 2011;61:232-4.