Epileptic seizure discharges in patients after open chamber cardiac surgery—a prospective prevalence pilot study using continuous electroencephalography

• Published in: Intensive care medicine 2020-07, Vol.46 (7), p.1418-1424
• Main Authors: Tschernatsch, Marlene, Juenemann, Martin, Alhaidar, Fouad, El Shazly, Jasmin, Butz, Marius, Meyer, Marco, Gerriets, Tibo, Schönburg, Markus, Schramm, Patrick
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesiology; Cardiac patients; Cardiac Surgical Procedures - adverse effects; Convulsions & seizures; Critical Care Medicine; Delirium; EEG; Electroencephalography; Emergency Medicine; Epilepsy; Heart; Heart surgery; Humans; Intensive; Intensive care; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mental disorders; Morbidity; Original; Pain Medicine; Patient Discharge; Patients; Pediatrics; Pilot Projects; Pneumology/Respiratory System; Prevalence; Prospective Studies; Quality of Life; Recording; Remifentanil; Retrospective Studies; Seizures; Seizures (Medicine); Seizures - diagnosis; Seizures - epidemiology; Seizures - etiology; Sufentanil; Surgery
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-020-06073-8

Purpose Patients undergoing cardiac surgery often develop delirium which increases the risk of postoperative morbidity and leads to a reduced quality of life. Retrospective studies show a higher incidence of delirium in patients with seizures. However, these studies do not systematically detect subclinical seizures, so the incidence of seizures after cardiac surgery remains speculative. The objective of this study is to determine the prevalence of electrographic seizures after elective open-chamber cardiac surgery. Methods This prospective, blinded, monocentric, observational study investigated patients scheduled for elective open-chamber valve reconstruction or replacement. Anaesthesia, surgery and postoperative treatment were standardized and not influenced by the presented observation. After surgery, all patients arrived at the ICU, and EEG monitoring started within the first hour. EEG recording was continuously performed for up to 24 h, and the results were independently analysed by two blinded EEG board-certified neurologists. Results 100 patients were included. Abnormal EEG patterns were present in 33% of patients, and 9% of all patients showed electrographic seizures. The main EEG activity at the beginning of each recording was suppressed or showed a burst-suppression pattern, and at the end of recording, all patients had an alpha/theta rhythm. An association between electrographic seizures and delirium was found ( p χ 2