Seizures in an Alzheimer's disease patient as a complication of colonoscopy premedication with meperidine

Seizures and Meperidine: Overstated and Underutilized

Meperidine is used for pain control and treatment of shivering. Concerns about neurotoxicity, particularly seizures, have led to efforts limiting meperidine use. We reviewed the body of evidence linking meperidine to seizures. We searched PubMed for the terms meperidine, normeperidine, pethidine, and norpethidine; each was combined with the terms: seizure, epilepsy, epileptogenic, toxicity, overdose, seizure threshold, and convulsion. Articles were assessed for relevance. Semiologies were reviewed to ascertain seizure likelihood. Our search yielded 351 articles, of which 66 were relevant. Of these, 33 had primary clinical data on meperidine-associated seizures, comprising 50 patients. Twenty events were deemed likely to be seizures, 26 indeterminate, and 4 unlikely. Most studies were case reports. Confounding comorbidities were frequent. The evidence base for meperidine-associated seizures in man is scant. Seizure risk associated with meperidine appears to be overstated. The utility of meperidine should continue to be explored, especially for therapeutic hypothermia.

Anaesthesia for the patient with dementia undergoing outpatient surgery

PURPOSE OF REVIEW

Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery.

RECENT FINDINGS

Demented patients often receive prescribed medication that can interact with various anaesthetic drugs and cause serious side effects. The anaesthesiologist should consider this when choosing the drugs used during surgery and when relieving postoperative pain. Generally, hypnotics, opioids, and inhalational anaesthetics should be administered in lower doses and carefully titrated because of altered pharmacokinetics and pharmacodynamics leading to a great variability, as documented in elderly patients. Neuromuscular blocking agents, and especially rocuronium, display an increased variability in the duration of action, but the new drug sugammadex may reverse the neuromuscular block in a few minutes. Postoperative cognitive decline is more frequent in elderly patients with preexisting cognitive impairment and several preventive measurements can be provided.

SUMMARY

Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.