Anesthetic Requirements in Patients with Medically Refractory Seizures Undergoing Neurosurgery

Background: Antiepileptic drugs (AEDs) are known to alter the requirement of anesthetic agents depending on their interaction with these agents. We performed a study to test the hypothesis that the requirement of propofol for induction and maintenance of anesthesia in patients with medically refractory seizures (MRS) on multiple AEDs will be altered when compared with that in patients on single AED.

Materials and Methods: We conducted a prospective observational study on neurosurgical patients in our hospital. Anesthesia was induced and maintained with propofol using Schnider’s protocol using a target control infusion (TCI) pump, along with fentanyl and atracurium in all patients. The effect site concentration of propofol (Ce) was titrated to target a bispectral index (BIS) of 45 to 55. The dose of propofol required for induction, Ce of propofol for maintenance, fentanyl requirement, and emergence parameters were noted and compared with that of patients on levetiracetam. Data were analyzed using unpaired student t-test for parametric data and Chi-square test for nonparametric data.

Results: We recruited 34 patients with MRS on multiple AEDs and 10 patients with levetiracetam in our study. Patients with MRS were found to have significantly lower requirement of propofol for induction and maintenance, and had rapid emergence, when compared with patients on levetiracetam (p < 0.05). Requirement of fentanyl was also less in patients with MRS, when compared with levetiracetam group, but this was not statistically significant.

Conclusions: Patients with MRS on multiple AEDs have lower propofol requirements during induction and maintenance of anesthesia.

Publication History

Article published online:
25 March 2020