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Seizures after percutaneous endoscopic lumbar discectomy: A case report

RATIONALE: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for removing nucleus pulposus and achieving neural decompression via a posterolateral approach. PELD is known to have a very low rate of complications during the perioperative period. Although quite rare, s...

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Autores principales: Wu, Junbei, Fang, Yin, Jin, Wenjie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676575/
https://www.ncbi.nlm.nih.gov/pubmed/33217789
http://dx.doi.org/10.1097/MD.0000000000022470
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author Wu, Junbei
Fang, Yin
Jin, Wenjie
author_facet Wu, Junbei
Fang, Yin
Jin, Wenjie
author_sort Wu, Junbei
collection PubMed
description RATIONALE: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for removing nucleus pulposus and achieving neural decompression via a posterolateral approach. PELD is known to have a very low rate of complications during the perioperative period. Although quite rare, seizures can occur in patients undergoing PELD. PATIENT CONCERNS: A 58-year-old man with severe low back pain underwent the PELD procedure under general anesthesia. During the recovery phase after general anesthesia, the patient developed a tonic-clonic seizure. Two additional episodes occurred subsequently. DIAGNOSES: Bilateral disc swelling indirectly supports the diagnosis of intracranial hypertension. INTERVENTIONS: Midazolam and propofol were administered to control seizures. 1.0 g phenobarbital sodium was administered by intravenous injection. Ten milligrams of furosemide and 250 mL of mannitol (20%) were prescribed sequentially. Two hundred milligrams of hydrocortisone and an ice bag were used to protect the brain. Urapidil, metoprolol, and nicardipine were intermittently used to control his blood pressure. A sustained release of sodium valproate was administered and continued prophylactically for 4 weeks. OUTCOMES: No further seizures were recorded and the patient recovered well. LESSONS: We conclude that total volume of fluid used for irrigation was considered a possible cause of seizure. This case illustrates the fact that irrigation should be performed cautiously in PELD procedure. And anesthesiologists should be familiar with the management strategies of perioperative acute seizures.
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spelling pubmed-76765752020-11-24 Seizures after percutaneous endoscopic lumbar discectomy: A case report Wu, Junbei Fang, Yin Jin, Wenjie Medicine (Baltimore) 3300 RATIONALE: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for removing nucleus pulposus and achieving neural decompression via a posterolateral approach. PELD is known to have a very low rate of complications during the perioperative period. Although quite rare, seizures can occur in patients undergoing PELD. PATIENT CONCERNS: A 58-year-old man with severe low back pain underwent the PELD procedure under general anesthesia. During the recovery phase after general anesthesia, the patient developed a tonic-clonic seizure. Two additional episodes occurred subsequently. DIAGNOSES: Bilateral disc swelling indirectly supports the diagnosis of intracranial hypertension. INTERVENTIONS: Midazolam and propofol were administered to control seizures. 1.0 g phenobarbital sodium was administered by intravenous injection. Ten milligrams of furosemide and 250 mL of mannitol (20%) were prescribed sequentially. Two hundred milligrams of hydrocortisone and an ice bag were used to protect the brain. Urapidil, metoprolol, and nicardipine were intermittently used to control his blood pressure. A sustained release of sodium valproate was administered and continued prophylactically for 4 weeks. OUTCOMES: No further seizures were recorded and the patient recovered well. LESSONS: We conclude that total volume of fluid used for irrigation was considered a possible cause of seizure. This case illustrates the fact that irrigation should be performed cautiously in PELD procedure. And anesthesiologists should be familiar with the management strategies of perioperative acute seizures. Lippincott Williams & Wilkins 2020-11-20 /pmc/articles/PMC7676575/ /pubmed/33217789 http://dx.doi.org/10.1097/MD.0000000000022470 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3300
Wu, Junbei
Fang, Yin
Jin, Wenjie
Seizures after percutaneous endoscopic lumbar discectomy: A case report
title Seizures after percutaneous endoscopic lumbar discectomy: A case report
title_full Seizures after percutaneous endoscopic lumbar discectomy: A case report
title_fullStr Seizures after percutaneous endoscopic lumbar discectomy: A case report
title_full_unstemmed Seizures after percutaneous endoscopic lumbar discectomy: A case report
title_short Seizures after percutaneous endoscopic lumbar discectomy: A case report
title_sort seizures after percutaneous endoscopic lumbar discectomy: a case report
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676575/
https://www.ncbi.nlm.nih.gov/pubmed/33217789
http://dx.doi.org/10.1097/MD.0000000000022470
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