Abstract
We present a case series of four cerebellopontine angle surgeries with intraoperative
detection seizure activity. The cases discussed follow the uniform anesthetic protocol
of maintenance with infusion of propofol, fentanyl and dexmedetomidine excluding muscle
relaxant, targeted to maintain bispectral index (BIS) in the range of 40 to 60. The
cases experienced either of the two scenarios: (I) Unexplained increased or widely
varying BIS values associated with increases in BIS electromyography (EMG) and motor
manifestation of seizure activity in limbs. (2) Varying BIS values with EMG activation
of facial nerve monitoring without motor manifestation in limbs. A common theme noticed
in all these cases was the utilisation of tranexamic acid in cumulative doses of 25
to 30 mg/kg and amelioration of the seizure activity with a loading dose of phenytoin
(15 mg/kg). A hypothesis is being presented linking intraoperative seizures with a
combination of tranexamic acid utilisation.
Keywords
intraoperative seizures - posterior fossa surgery - tranexamic acid
