Typically, outpatient surgery can be more convenient and less costly for patients. However, not all cases are suitable for the outpatient setting, given that the capacity for managing medical emergencies and providing critical care is limited. For individuals with seizures, whether controlled or uncontrolled, undergoing outpatient surgery presents unique challenges and considerations.
Controlled seizures refer to the condition being effectively managed with medication or other therapies, with patients no longer or rarely experiencing seizures, whereas uncontrolled seizures persist despite any treatment efforts. Controlled and uncontrolled seizures have significantly different impacts on preoperative, intraoperative, and postoperative care. Understanding these discrepancies is vital for healthcare providers to ensure patient safety and optimize outcomes 1.
Patients with controlled seizures often undergo routine preoperative assessments before outpatient surgery, including medical history reviews, physical examinations, and laboratory tests. However, additional attention is required to evaluate the effectiveness of any antiepileptic drugs (AEDs) the patient is taking and potential drug interactions with anesthesia.
Individuals with uncontrolled seizures, however, require a more comprehensive evaluation to identify seizure triggers, frequency, and severity. Collaboration between neurologists and anesthesiologists is crucial to develop tailored management strategies, potentially adjusting AED regimens, or exploring alternative treatment modalities.
Research has found that the majority of perioperative seizures in patients with a pre-existing seizure disorder are likely related to the patient’s underlying condition, and that the frequency of seizures is not influenced by the type of anesthesia or procedure. Therefore, because patients with frequent seizures at baseline are relatively likely to experience a seizure in the perioperative period, it is essential to be prepared to treat seizure activity regardless of the surgical procedure or anesthetic technique 3.
During outpatient surgery, maintaining seizure control is paramount to preventing complications and ensure procedural success. Patients with controlled seizures typically undergo standard anesthesia protocols, with careful monitoring to mitigate the risk of breakthrough seizures.
For those with uncontrolled seizures, anesthetic management is more complex. Anesthesiologists must select agents with minimal epileptogenic potential while ensuring adequate sedation and pain control. Continuous electroencephalography (EEG) monitoring may be warranted to promptly detect seizure activity and intervene accordingly 4.
Following outpatient surgery, patients with controlled seizures usually resume their regular AED regimen under close monitoring 5. Discharge planning includes educating patients and caregivers about recognizing seizure triggers and implementing appropriate safety measures.
In contrast, individuals with uncontrolled seizures may experience prolonged recovery periods and heightened susceptibility to postoperative complications. Multidisciplinary collaboration involving neurologists, epileptologists, and primary care providers is essential to optimize seizure management and prevent adverse outcomes.
Navigating outpatient surgery for patients with seizures warrants a nuanced approach that acknowledges the diversity of seizure presentations and treatment responses. It is necessary to properly evaluate the perioperative risks associated with seizures, such as airway compromise, hemodynamic instability, and medication interactions. For some cases, the best course of action may be to have the surgery performed at a hospital rather than a free-standing outpatient surgery center. It is also important to use advanced monitoring techniques, such as EEG and video monitoring, to anticipate and mitigate seizure-related complications during surgery. Finally, it is essential to optimize AED regimens to minimize perioperative seizure risk while avoiding adverse drug interactions and pharmacokinetic alterations 4.
Outpatient surgery offers many benefits for patients, but special considerations are required for patients with seizures. By integrating multidisciplinary expertise and personalized care plans, the perioperative team can optimize patient outcomes.
References
1. Surgery for Epilepsy | UC San Diego Health. Available at: https://health.ucsd.edu/care/neurological/epilepsy/surgery/. (Accessed: 28th March 2024)
2. Types of Epilepsy Surgery | Epilepsy Foundation. Available at: https://www.epilepsy.com/treatment/surgery/types. (Accessed: 28th March 2024)
3. Niesen, A. D. et al. Perioperative seizures in patients with a history of a seizure disorder. Anesth. Analg. 111, 729–735 (2010). DOI: 10.1213/ANE.0b013e3181e534a4
4. Bajwa, S. J. S. & Jindal, R. Epilepsy and nonepilepsy surgery: Recent advancements in anesthesia management. Anesth. Essays Res. 7, 10 (2013). doi: 10.4103/0259-1162.113978
5. Epilepsy surgery – Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/epilepsy-surgery/about/pac-20393981. (Accessed: 28th March 2024)