Epileptiform activity during induction of anesthesia with sevoflurane prior to elective carotid endarterectomy

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Denise AB Smith ◽  
Jonathan Bath
Keyword(s):  
Carotid Endarterectomy ◽  
Patient Population ◽  
Epileptiform Activity ◽  
Pediatric Anesthesia ◽  
Anesthetic Technique ◽  
High Grade ◽  
Carotid Surgery ◽  
Sevoflurane Anesthesia ◽  
Epileptiform Discharges ◽  
Induction Agents

The optimal anesthetic technique for carotid endarterectomy is still controversial. For general anesthesia, various induction agents have been used. We present two patients with asymptomatic high-grade carotid stenosis where induction with sevoflurane resulted in epileptiform discharges seen on perioperative electroencephalogram monitoring without adverse clinical sequelae. The occurrence of epileptogenic electroencephalogram during sevoflurane anesthesia has been widely described despite its popular use in pediatric anesthesia. This phenomenon, however, has not been previously described during electroencephalogram monitoring in carotid surgery. The authors suggest that induction anesthesia with sevoflurane should be avoided in this patient population especially where routine electroencephalogram monitoring is not performed.

scholarly journals Induction of Tertiary Phase Epileptiform Discharges after Postasphyxial Infusion of a Toll-Like Receptor 7 Agonist in Preterm Fetal Sheep

2021 ◽  
Vol 22 (12) ◽  
pp. 6593
Author(s):  
Kenta H.T. Cho ◽  
Mhoyra Fraser ◽  
Bing Xu ◽  
Justin M. Dean ◽  
Alistair J. Gunn ◽  
...  
Keyword(s):  
Moderate Hypertension ◽  
Epileptiform Activity ◽  
Ischemic Brain Injury ◽  
Toll Like Receptor ◽  
Fetal Sheep ◽  
Ischemic Brain ◽  
Tlr Agonists ◽  
Epileptiform Discharges ◽  
Subcortical Regions ◽  
Total Burden

Background: Toll-like receptor (TLR) agonists are key immunomodulatory factors that can markedly ameliorate or exacerbate hypoxic–ischemic brain injury. We recently demonstrated that central infusion of the TLR7 agonist Gardiquimod (GDQ) following asphyxia was highly neuroprotective after 3 days but not 7 days of recovery. We hypothesize that this apparent transient neuroprotection is associated with modulation of seizure-genic processes and hemodynamic control. Methods: Fetuses received sham asphyxia or asphyxia induced by umbilical cord occlusion (20.9 ± 0.5 min) and were monitored continuously for 7 days. GDQ 3.34 mg or vehicle were infused intracerebroventricularly from 1 to 4 h after asphyxia. Results: GDQ infusion was associated with sustained moderate hypertension that resolved after 72 h recovery. Electrophysiologically, GDQ infusion was associated with reduced number and burden of postasphyxial seizures in the first 18 h of recovery (p < 0.05). Subsequently, GDQ was associated with induction of slow rhythmic epileptiform discharges (EDs) from 72 to 96 h of recovery (p < 0.05 vs asphyxia + vehicle). The total burden of EDs was associated with reduced numbers of neurons in the caudate nucleus (r2 = 0.61, p < 0.05) and CA1/2 hippocampal region (r2 = 0.66, p < 0.05). Conclusion: These data demonstrate that TLR7 activation by GDQ modulated blood pressure and suppressed seizures in the early phase of postasphyxial recovery, with subsequent prolonged induction of epileptiform activity. Speculatively, this may reflect delayed loss of early protection or contribute to differential neuronal survival in subcortical regions.

Postendarterectomy Common Carotid Artery Pseudoaneurysm

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 177-180 ◽  
Author(s):  
Nenad S. Ilijevski ◽  
Predrag Gajin ◽  
Vojislava Neskovic ◽  
Jovo Kolar ◽  
Djordje Radak
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Carotid Surgery ◽  
Artery Pseudoaneurysm ◽  
Adjacent Structures ◽  
Uncommon Complication

Pseudoaneurysm (PSA) formation is an uncommon complication in carotid surgery. PSA of the carotid artery requires surgical or endovascular treatment to prevent PSA thrombosis, embolization from the thrombotic material within the PSA, hemorrhage after rupture, or compression on the adjacent structures. We present a case of a symptomatic common carotid PSA that occurred 14 months after routinely performed eversion carotid endarterectomy.

Immediate and Long-Term Results of Carotid Endarterectomy for Asymptomatic High-Grade Stenosis

1994 ◽  
Vol 8 (2) ◽  
pp. 144-149 ◽  
Author(s):  
Thomas S. Riles ◽  
Frederick S. Fisher ◽  
Patrick J. Lamparello ◽  
Gary Giangola ◽  
Lee Gibstein ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Long Term Results ◽  
High Grade

Enhanced NMDAR-dependent epileptiform activity is controlled by oxidizing agents in a chronic model of temporal lobe epilepsy

1996 ◽  
Vol 76 (6) ◽  
pp. 4185-4189 ◽  
Author(s):  
J. C. Hirsch ◽  
O. Quesada ◽  
M. Esclapez ◽  
H. Gozlan ◽  
Y. Ben-Ari ◽  
...  
Keyword(s):  
Synaptic Transmission ◽  
Ex Vivo ◽  
Epileptiform Activity ◽  
Hippocampal Slices ◽  
Nmda Antagonist ◽  
Pyramidal Cells ◽  
Resting Membrane Potential ◽  
Postsynaptic Potentials ◽  
Epileptiform Discharges ◽  
Late Part

1. Graded N-methyl-D-aspartate receptor (NMDAR)-dependent epileptiform discharges were recorded from ex vivo hippocampal slices obtained from rats injected a week earlier with an intracerebroventricular dose of kainic acid. Intracellular recordings from pyramidal cells of the CA1 area showed that glutamate NMDAR actively participated in synaptic transmission, even at resting membrane potential. When NMDAR were pharmacologically isolated, graded burst discharges could still be evoked. 2. The oxidizing reagent 5,5'-dithiobis(2-nitrobenzoic acid) (DTNB, 200 microM, 15 min) suppressed the late part of the epileptiform burst that did not recover after wash but could be reinstated by the reducing agent tris (2-carboxyethyl) phosphine (TCEP, 200 microM, 15 min) and again abolished with the NMDA antagonist D-2-amino-5-phosphonovaleric acid (D-APV). 3. Pharmacologically isolated NMDAR-mediated responses were decreased by DTNB (56 +/- 10%, mean +/- SD, n = 6), an effect reversed by TCEP. 4. When only the fast glutamateric synaptic component was blocked, NMDA-dependent excitatory postsynaptic potentials (EPSPs) could be evoked despite the presence of underlying fast and slow inhibitory postsynaptic potentials (IPSPs). DTNB decreased EPSPs to 48 +/- 12% (n = 5) of control. 5. Since a decrease of the NMDAR-mediated response by +/- 50% is sufficient to suppress the late part of the burst, we suggest that epileptiform activity can be controlled by manipulation of the redox sites of NMDAR. Our observations raise the possibility of developing new anticonvulsant drugs that would spare alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid-R (AMPAR)-mediated synaptic responses and decrease NMDAR-mediated synaptic transmission without blocking it completely.

scholarly journals Epileptiform Discharges With In-Vivo-Like Features in Slices of Rat Piriform Cortex With Longitudinal Association Fibers

2001 ◽  
Vol 86 (5) ◽  
pp. 2445-2460 ◽  
Author(s):  
Rezan Demir ◽  
Lewis B. Haberly ◽  
Meyer B. Jackson
Keyword(s):  
Seizure Activity ◽  
Epileptiform Activity ◽  
Piriform Cortex ◽  
Brain Slices ◽  
Epileptiform Discharges ◽  
Local Circuitry ◽  
Association Fibers ◽  
Discharge Propagation

Brain slices serve as useful models for the investigation of epilepsy. However, the preparation of brain slices disrupts circuitry and severs axons, thus complicating efforts to relate epileptiform activity in vitro to seizure activity in vivo. This issue is relevant to studies in transverse slices of the piriform cortex (PC), the preparation of which disrupts extensive rostrocaudal fiber systems. In these slices, epileptiform discharges propagate slowly and in a wavelike manner, whereas such discharges in vivo propagate more rapidly and jump abruptly between layers. The objective of the present study was to identify fiber systems responsible for these differences. PC slices were prepared by cutting along three different nearly orthogonal planes (transverse, parasagittal, and longitudinal), and epileptiform discharges were imaged with a voltage-sensitive fluorescent dye. Interictal-like epileptiform activity was enabled by either a kindling-like induction process or disinhibition with bicuculline. The pattern of discharge onset was very similar in slices cut in different planes. As described previously in transverse PC slices, discharges were initiated in the endopiriform nucleus (En) and adjoining regions in a two-stage process, starting with low-amplitude “plateau activity” at one site and leading to an accelerating depolarization and discharge onset at another nearby site. The similar pattern of onset in slices of various orientations indicates that the local circuitry and neuronal properties in and around the En, rather than long-range fibers, assume dominant roles in the initiation of epileptiform activity. Subtle variations in the onset site indicate that interneurons can fine tune the site of discharge onset. In contrast to the mode of onset, discharge propagation showed striking variations. In longitudinal slices, where rostrocaudal association fibers are best preserved, discharge propagation resembled in vivo seizure activity in the following respects: propagation was as rapid as in vivo and about two to three times faster than in other slices; discharges jumped abruptly between the En and PC; and discharges had large amplitudes in superficial layers of the PC. Cuts in longitudinal slices that partially separated the PC from the En eliminated these unique features. These results help clarify why epileptiform activity differs between in vitro and in vivo experiments and suggest that rostrocaudal pyramidal cell association fibers play a major role in the propagation of discharges in the intact brain. The longitudinal PC slice, which best preserves these fibers, is ideally suited for the study their role.

scholarly journals Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

2014 ◽  
Author(s):  
Hani Annabi ◽  
Charles Fleischer ◽  
Robert Taylor ◽  
Steven Gruendling ◽  
joe pergolizzi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Anesthetic Technique ◽  
Hybrid Technique ◽  
Comorbid Conditions ◽  
Neurological Assessment ◽  
Left Neck ◽  
Artery Disease

There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our study was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.

Spontaneous interictal-like activity originates in multiple areas of the CA2-CA3 region of hippocampal slices

1994 ◽  
Vol 71 (4) ◽  
pp. 1574-1585 ◽  
Author(s):  
L. V. Colom ◽  
P. Saggau
Keyword(s):  
Guinea Pig ◽  
Epileptiform Activity ◽  
Hippocampal Slices ◽  
Optical Recording ◽  
Objective Lens ◽  
Gamma Aminobutyric Acid ◽  
Subsequent Increase ◽  
Epileptiform Discharges ◽  
High K ◽  
Ca3 Region

1. The sites of origin of spontaneous interictal-like epileptiform activity in hippocampal slices from guinea pig, mouse, and rat were determined. A multisite fast optical recording technique using voltage-sensitive dyes and an array of 100 photodiodes was employed. The use of a low-magnification objective lens allowed the visualization of almost the entire transverse hippocampal slice. Three in vitro models of epilepsy were employed, utilizing different manipulations of the bath perfusion medium to induce epileptiform activity: 1) raising the external potassium (K+) concentration, 2) adding the potassium channel blocker 4-aminopyridine (4-AP), and 3) adding antagonists of gamma-aminobutyric acid-A (GABAA) receptors (bicuculline and picrotoxin, BIC-PTX). 2. Spontaneous epileptiform discharges were detected in each subfield of cornu ammonis (CA) but not in the dentate gyrus (DG) of each studied species. Preliminary experiments confirmed that interictal-like epileptiform activity originated in the CA2-CA3 region. Ictal-like activity was never observed in our experiments. 3. In the guinea pig, when GABAA antagonists were employed, the site of origin of spontaneous epileptiform discharges was consistently located in the CA2-CA3a region. When high K+ or 4-AP was used, this region was the most frequent site of origin. Subsequent epileptiform discharges with similar sites of origin occasionally invaded different areas of the CA2-CA3 region, revealing a variable area of occupance of epileptiform discharges. 4. In the mouse and rat, the site of origin of spontaneous discharges was invariably located in the CA3b-CA3c region independent of the epilepsy model. 5. In both the guinea pig and rat, when the CA2-CA3a region was surgically separated from the CA3b-CA3c region, independent discharges were observed in both regions. Areas that could generate discharges only under certain epileptogenic conditions were found in these species (potential sites of origin). Two independent sites of origin with different propagation patterns and area of occupance were occasionally observed within the CA2-CA3a region. 6. In the guinea pig, such lesions demonstrated that both regions can independently generate epileptiform discharges at different frequencies. When high K+ or 4-AP was employed, epileptiform activity was observed in both regions. Although BIC-PTX only generated discharges in the CA2-CA3a region, a subsequent increase in K+ induced additional discharges in the CA3b-CA3c region, revealing a potential site of origin. 7. In rat hippocampal slices with such lesions, spontaneous epileptiform discharges were observed in both CA2-CA3a and CA3b-CA3c region when 4-AP was employed.(ABSTRACT TRUNCATED AT 400 WORDS)

Cerebral vasoconstriction after carotid endarterectomy

2018 ◽  
Vol 18 (5) ◽  
pp. 378-381 ◽  
Author(s):  
Diogo Fitas ◽  
Marta Carvalho ◽  
Pedro Castro ◽  
Pedro Abreu ◽  
Goreti Moreira ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Continuous Monitoring ◽  
Internal Carotid ◽  
Gradual Increase ◽  
Transcranial Doppler Ultrasound ◽  
Internal Carotid Artery Stenosis ◽  
Motor Deficits ◽  
High Grade ◽  
Cerebral Haemodynamics ◽  
Cerebral Vasoconstriction

Carotid endarterectomy carries the risk of several complications. We report a 55-year-old woman with recurrent cerebral vasoconstriction postoperatively. She had bilateral high-grade internal carotid artery stenosis and underwent right endarterectomy because of transient left-sided sensory symptoms. She developed a reperfusion syndrome with severe right-sided headache, right frontotemporal oedema and increased velocities in transcranial Doppler ultrasound. Given her gradual increase of velocities and Lindegaard index, together with fixed left sensory and motor deficits, we performed CT angiography, which suggested cerebral vasoconstriction syndrome. A subsequent left carotid endarterectomy triggered a similar cerebrovascular response. We highlight the need for continuous monitoring of cerebral haemodynamics following carotid endarterectomy.

Epileptiform Activity

2009 ◽  
pp. 137-150 ◽  
Author(s):  
Joseph F. Drazkowski
Keyword(s):  
Clinical Significance ◽  
Epileptiform Activity ◽  
Epileptiform Discharges ◽  
Important Test

EEG continues to be an important test to functionally evaluate people with suspected seizures. Although few specific EEG patterns exist for specific diseases, the presence of epileptiform discharges and patterns on the EEG may help identify certain syndromes. Clinicians using EEG in the evaluation and management of people with suspected epilepsy should be familiar with the different epileptiform discharges and their associated clinical significance.

scholarly journals Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

2019 ◽  
Vol 80 (05) ◽  
pp. 341-344
Author(s):  
Jan Mracek ◽  
Jakub Kletecka ◽  
Irena Holeckova ◽  
Jiri Dostal ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Postoperative Nausea And Vomiting ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Advantages And Disadvantages ◽  
Future Preference ◽  
Intraoperative Pain ◽  
Optimal Approach

Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

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