A Prospective Observational Study of Seizures After Cardiac Surgery Using Continuous EEG Monitoring

Abstract

Electrographic seizures occur infrequently after cardiac surgery and are generally associated with a good prognosis. Prophylactic cEEG monitoring is unlikely to be cost-effective in this population. (ClinicalTrials.gov Identifier: NCT01291992).

Nonischemic Postoperative Seizure Does Not Increase Mortality After Cardiac Surgery

“…However, because of the design of the statistical analysis grouping the variables together, no inference on the specific effect of PS on outcome could be made in this study. In the few subsequent series published on the topic, the incidence of PS varied from 0.9% to 3.6% [5,6,14,15]. This large heterogeneity is likely the result of differences in patient population, type of surgery, intraoperative medications, and more importantly, the definition of seizure and the type of monitoring.…”

Tranexamic acid–associated seizures: Causes and treatment

“…However, observational clinical trials and case reports have shown that TXA, and to a lesser extent EACA, but not aprotinin, are associated with seizures 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34. Most TXA‐associated seizures occur in patients who have undergone cardiac procedures 16, 17, 18, 20, 21, 24, 25, 26, 30, 31, 32, 34. However, several case reports indicate that TXA‐associated seizures also occur in nonsurgical patients 10, 22, 27.…”

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery

“…3 In the trial, the low dose of tranexamic acid was not safer than the high dose in terms of the risk of seizure (0.7% vs. 0.6%) but was associated with significantly lower efficacy in terms of blood loss (P = 0.03 for interaction) and number of units transfused (P = 0.02 for interaction). Moreover, plasma concentrations of tranexamic acid were aimed to be effective for 6 to 8 hours, but no target concentrations or intraoperative measurements of concentrations are mentioned.…”

“…1,3 This reduction triggers seizure-like events in animal models. Commonly used general anesthetics, including propofol and sevoflurane, which increase glycine receptor and GABA A receptor function, rapidly reverse the tranexamic acid inhibition of these receptors.…”

“…We note that the diagnosis of seizures was based solely on clinical observation, although a proportion of the seizures among patients after cardiac surgery are known to be nonconvulsive, 3 and diagnosis may be obscured by the use of muscle relaxants and shivering after passive hypothermia. Accurate diagnosis of seizures in patients after cardiac surgery is essential because seizures are associated with higher mortality, longer length of hospital stay, a higher incidence of delirium and stroke, and a lower quality of life.…”