Seizure under GA

RE: Seizure under GA

Kathryn Burton — Thu, 20 Sep 2018 14:07:54 GMT

Thank you everyone for your wisdom. Hopefully my next GA will run more smoothly!

RE: Seizure under GA

vs0u — Sat, 15 Sep 2018 15:21:37 GMT

If the dog was properly under anaesthetic it couldn't have a seizure - giving propofol stops seizures - so I would think it must have been waking up/getting light and going into the excitement phase of anaesthesia. Propofol wears off in 5 mins (and is meant to be given slowly) so unlikely to be due to that. I think it's more likely to be a problem with the gaseous anaesthesia E.g. Iso not turned up enough, oxygen flow rate too low, et tube not fitting correctly, wrong circuit, dog not breathing much?

I would try and work with a good nurse who's familiar with the circuit and set up for a few ops, and see if you get any more issues.

RE: Seizure under GA

Anthony Dennison — Fri, 14 Sep 2018 17:01:45 GMT

[quote user="janine redman"]could it have been an excitement reaction[/quote]

That's the phrase! Voluntary and Involuntary Excitement.

RE: Seizure under GA

janine redman — Fri, 14 Sep 2018 16:46:29 GMT

Depending on the experience of Your Veterinary nurse could it have been an excitement reaction where the propofol was wearing off but the isoflurane anaesthetic depth was not adequate? With propoflo given slowly to effect and with low levels of premed,( I used to use 1ml per 20 kg when I started in practice several or more years ago ), patients will sometimes go through an involuntary excitement reaction as the anaesthesia deepens.

RE: Seizure under GA

Anthony Dennison — Fri, 14 Sep 2018 15:36:34 GMT

I don't think this was a seizure, it sounds like 'unconscious activity' (not the correct technical term, I had it in my head but as soon as I started writing this post it's gone!) which is part of the induction process. You get some conscious activity to start with, then unconscious activity (like you've described), then full anaesthesia. We see it quite commonly, so always draw up a few ml extra than needed. On the GA monitoring sheet we'll put the amount of propofol calculated followed by the amount drawn up in brackets. I often find if inducing through an i/v cannula you need at least an extra 1-2ml than calculated anyway.

RE: Seizure under GA

Jill Butterworth — Fri, 14 Sep 2018 15:30:17 GMT

Careful it doesn't knock your confidence for a while, as you were very unlucky. This used to happen more at one practice than others I've worked at since, so I put it down to nursing and the premed difference but it was so long ago, I can't remember the detail. I've occasionally had it happen in the middle of a big op and you have no choice but to keep on operating and praying, but I try to get another vet/nurse for 2nd opinion if it's happening to double check they are not too light/too deep.

I generally draw up more propofol than is needed, just in case they don't go to sleep, or have a second preloaded syringe ready.

I would talk it over with the other vets at work and ask to do ops in the main surgery for a while to get your confidence/experience back up to speed rather than avoiding them.

Bob's suggestion of having emergency drug doses ready on the GA sheet is good. You are unlikely ever to need them, but it's great to have as many security blankets as possible.

RE: Seizure under GA

Iain Richards — Fri, 14 Sep 2018 15:18:33 GMT

Propofol paddling, plus underdose. Not uncommon.

RE: Seizure under GA

Martin Atkinson — Fri, 14 Sep 2018 13:48:40 GMT

It is not uncommon IME for dogs and cats to have a 'seizure' like this under induction or on recovery. The nurses get themselves into a bit of a state over it but I usually just monitor vital parameters and make sure the depth of anaesthesia is correct if under GA or that the seizure stops if they are recovering which they invariably do with no further intervention. I've never had one that has had a further complication or found that it relates in anyway to any known history of seizures or the likelihood of the patient developing seizures post op. Nystagmus/strabismus like syndromes occur fairly frequently in animals during induction/recovery and I've not found that this relates to a more serious iatrogenic or underlying CNS issue.

So don't beat yourself up over this, I can't see it relates to anything you perceive you did wrong and what you did in response was appropriate. I can see if the induction dose of propofol was too small and the dog was too light there may have been some activity related to this but that happens to all of us occasionally.