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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(03): 516-521
DOI: 10.1055/s-0043-1771365
Original Article

Emergence Patterns from General Anesthesia after Epilepsy Surgery: An Observational Pilot Study

Lashmi Venkatraghavan
1   Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Suparna Bhardwaj
2   Department of Neuro Anaesthesia & Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
,
Sujoy Banik 
3   Department of Anesthesia and Perioperative medicine, Western University, London, Canada
,
Tumul Chowdhury
1   Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Mary Pat McAndrews
4   Department of Neuropsychology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
,
Taufik Valiante
5   Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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Abstract

Objective Emergence from anesthesia starts from the limbic structures and then spreads outwards to brainstem, reticular activating systems, and then to the cortex. Epilepsy surgery often involves resection of limbic structures and hence may disrupt the pattern of emergence. The aim of this study was to explore the pattern of emergence from anesthesia following epilepsy surgery and to determine associated variables affecting the emergence pattern.

Setting and Design Tertiary care center, prospective observational study.

Materials and Methods We conducted a prospective observation pilot study on adult patients undergoing anterior temporal lobectomy and amygdalohippocampectomy for epilepsy. Anesthesia management was standardized in all patients, and they were allowed to wake up with “no touch” technique. Primary outcome of the study was the pattern of emergence (normal emergence, agitated emergence, or slow emergence) from anesthesia. Secondary outcomes were to explore the differences in preoperative neuropsychological profile and limbic structure volumes between the different patterns of emergence. Quantitative variables were analyzed using Student's t-test. Qualitative variables were analyzed using chi-square test.

Results Twenty-nine patients completed the study: 9 patients (31%) had agitated emergence, and 20 patients had normal emergence. Among the agitated emergence, 2 patients had Riker scale of 7 indicating violent emergence. Patient demographics, anesthetic used, neuropsychological profile, and limbic structure volumes were similar between normal emergence and agitated emergence groups. However, two patients who had severe agitation (Riker scale of 7) had the lowest intelligence quotient.

Conclusion Our pilot study showed that emergence agitation is not uncommon in patients undergoing epilepsy surgery. However, due to smaller sample size, the role of preoperative neuropsychologic profile and hippocampal volumes in predicting the pattern of emergence is inconclusive.

Keywords

epilepsy surgery - emergence - agitation - anesthesia

Ethical Approval

This study was approved by the institutional ethical committee under the ID: UHN REB # 14-8212BE, December 2, 2014.


Trial Registration

The study is registered at http://clinicaltrials.gov under registration ID NCT02360098.


Author's Contributions

LV and SBh contributed to the concepts, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review. SBa contributed to the definition of intellectual content, literature search, data analysis, statistical analysis, manuscript preparation, manuscript editing, and manuscript review. TC contributed to the design, definition of intellectual content, manuscript preparation, manuscript editing, and manuscript review. MPMcA contributed to the concepts, design, definition of intellectual content, clinical studies, data acquisition, data analysis, statistical analysis, manuscript editing, and manuscript review. TV contributed to the concepts, design, definition of intellectual content, clinical studies, data acquisition, manuscript editing, and manuscript review. LV serves as the guarantor of the research.




Publication History

Article published online:
22 September 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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