Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

Background: Nonconvulsive status epilepticus (NCSE) is induced by common neurosurgical conditions, for example, trauma, stroke, tumors, and surgical interventions in the brain. The aggressiveness of the treatment for NCSE depends on its neurological prognosis. Aphasic status epilepticus (ASE) is a subtype of focal NCSE without consciousness impairment. The impact of ASE on neurological prognosis is poorly documented. We describe a case of postoperative ASE resulting in verbal and memory deficits. Case Description: A 54-year-old, right-handed man with focal impaired awareness seizures underwent partial resection for a left temporal lobe tumor. No neurological deficits were observed immediately after surgery. Three days later, however, a focal to bilateral tonic-clonic seizure (FBTCS) occurred, followed by aphasia. Electroencephalography revealed 1.5 Hz left-sided periodic discharges. He was diagnosed with ASE. Multiple anti-seizure drugs were ineffective for the resolution of the patient’s verbal disturbance. Nine days after the FBTCS, deep sedation with intravenous anesthetics was performed and the ASE stopped. Thereafter, his symptoms gradually improved. However, the prolonged ASE resulted in verbal and memory deficits. Automated hippocampal volumetry revealed an approximate decrease of 20% on the diseased side on magnetic resonance imaging 3 months after surgery. Conclusion: Prolonged ASE can induce verbal and memory deficits. Early intervention with intravenous anesthetics is required to obtain a favorable neurological prognosis.

EFFICACY AND SAFETY OF PROPOFOL AS COMPARE TO OTHER ANESTHETICS : A SYSTEMATIC REVIEW AND META-ANALYSIS

Propofol is used in most of surgical, endoscopic and colonoscopy procedures which commonly requires general anesthesia, and propofol is one of the most widely used intravenous anesthetics. Propofol is known to have many advantages over other anesthetic agents, including rapid induction of anesthesia, early recovery, and fewer complications such as postoperative nausea and vomiting.1

An IV Anesthetic Decision Tree for Cardiac Surgery

A thorough literature review was conducted covering the topics Intravenous anesthetics, pathophysiology of structural heart disease, and decision-making in anesthesia. A systematic review of randomized controlled trials was performed guided by the PRISMA protocol. Through the lens of Information Processing Theory, the results of the systematic review were used to guide the creation of a decision tree for the selection of the appropriate intravenous anesthetic for cardiac surgery.