Post Your Cases > post op seizure in PACU

55 y/o male S/P laparoscopic inguinal hernia repair under GA with wound infiltration with 20 mL 1% lidocaine and 30 mL 0.5% bupivacaine by the surgeon under laparoscopic guidance. Patient had rocuronium reversed with neostigmine and was extubated in OR. Post extubation he began shaking. Sugammadex was given for suspected residual muscle weakness, with 50mg Propofol for agitation. His respirations were improved and he was following commands. On arrival to PACU he began seizing and was given 2mg midazolam. He remained in normal sinus rhythm. No improvement was noted with seizure activity. 50 mL bolus of 20% intralipid was given. Seizure activity stopped immediately and he became responsive once again. He denies any recall of these events.
December 30, 2016 | Unregistered CommenterR Oconer, DO
Thanks for posting this interesting case, Dr. Oconer. I like to see, 'immediate' and 'responsive once again'. This experience agrees with the few I've seen where patients were clear as a bell after the seizure treated with lipid: that is, there was no post-ictal phase. I'm glad to read of the good outcome and that there was no cardiovascular compromise. Nice job!
February 5, 2017 | Registered Commenter[Guy Weinberg]