2018 Volume 39 Issue 2 Pages 143-147
Lennox-Gastaut syndrome（LGS）is a disease characterized by refractory epileptic seizures and mental retardation. Anesthetic management problems include prevention of epileptic seizures and attention to the interaction between anesthetics and internal medications. We report the anesthetic management of a patient with LGS with propofol alone.
The patient was a 43-year-old female who had been diagnosed with LGS at 2 years of age. Her concurrent medications included carbamazepine, clobazam, topiramate and rufinamide daily. A dental procedure under intravenous sedation was planned because of difficulty of retaining oral opening.
The patient experienced a small seizure before the first anesthesia, and was feeling sleepy before induction. A 20-mg dose of propofol was administered and sedation maintained at 4 mg/kg/h such that the BIS value was 60-70. Significant hemodynamic changes and respiratory depression were not observed during the operation. She was awake on the second occasion and a 50-mg dose of propofol was administered；sedation was maintained at 2-6 mg/kg/h such that the BIS value was 40-60. Epileptic seizures were not observed on either occasion.
Benzodiazepines（BZ）are effective in preventing epileptic seizures, and this patient was on clobazam therapy. Flumazenil, a BZ antagonist, acts by competitively inhibiting BZ binding to the GABAA receptor. When such patients are sedated with BZ and delay in arousal occurs, administration of flumazenil may decrease the efficacy of clobazam and precipitate a seizure. Therefore, only propofol with a short context-sensitive half-time was used in this case, and the patient was maintained under deep sedation to prevent the occurrence of a seizure. The BIS monitor, which measures sedation degree, is also useful for anesthesia management of epilepsy patients who have difficulty communicating because it continuously monitors brain waves.
