Abstract
Nonconvulsive status epilepticus (NCSE) presents as a disorder of consciousness and has few other clinical findings. Electroencephalography (EEG) is crucial for its diagnosis. We analyzed 11 NCSE cases that presented with delayed emergence from anesthesia after cardiovascular surgery with cardiopulmonary bypass (CPB). EEG revealed epileptic spikes in all these cases, which were treated accordingly. NCSE was diagnosed in 11 of 433 cases of adult cardiovascular surgery with CPB, and 9 of 11 cases showed improvement in consciousness after treatment for epilepsy. Multivariate analysis revealed the following 4 risk factors for NCSE: arteriosclerosis obliterans, atrial fibrillation, CPB for more than 180 min, and use of tranexamic acid. NCSE should always be differentiated from the disorder of consciousness after cardiovascular surgery, and early EEG is necessary for its diagnosis. Furthermore, if EEG reveals epileptic spikes, patients should be treated accordingly. Moreover, intraoperative use of tranexamic acid is considered to be one of the risk factors for NCSE; therefore, it should be used selectively for cases at high risk of bleeding.
