A Case of Generalized Tonic Convulsion after General Anesthesia

Abstract

  A 37-year-old man (weight : 66 kg, height : 178 cm) was scheduled to undergo the extraction of wisdom teeth and an accompanying cystic lesion. He had a history of febrile convulsions during childhood. Anesthesia was induced intravenously using propofol and fentanyl. Nasal-tracheal intubation was then facilitated with rocuronium bromide. The anesthesia was maintained with O₂-air-sevoflurane, with an end-tidal sevoflurane concentration of under 2.4%. The surgical procedures were performed uneventfully, and no specific problems occurred during the operation. At the end of the surgery, sugammadex (200 mg) was administrated intravenously to reverse the neuromuscular blockade. The tracheal tube was extubatd after sufficient spontaneous breathing was resumed (end-tidal carbon dioxide, 45-50 mmHg ; end-tidal sevoflurane, 0.3%). After extubation, a generalized tonic convulsion occurred involving a loss of consciousness and respiratory arrest. Manual ventilation was impossible, and the patient’s Spo₂ level decreased to 70%. The convulsion lasted approximately one minute. On the day after surgery, the results of an electroencephalograph, brain CT and biochemical study were normal. Therefore, the cause of the convulsion remains uncertain. However, several case reports of convulsion after the administration of sevoflurane, sugammadex sodium, and propofol have been reported. Careful attention should be paid to the general condition of patients with a history of convulsions (even during early childhood) when using these drugs.