title: Grand mal seizure induced by low-dose fentanyl and lidocaine in a young child.
abstract: Surgical procedures require general anesthesia using combinations of drugs including fentanyl and/or lidocaine. Because many of these drugs have bimodal anticonvulsant/proconvulsant effects, they must be administered carefully. We herein report a case of seizure attack during anesthesia induction with low-dose fentanyl and lidocaine in a young child with no history of seizures. A 10-year-old girl was scheduled to receive an elective tenectomy. After a few seconds of fentanyl and lidocaine administration for anesthesia induction, she developed generalized tonic-clonic seizures. Seizures subsided spontaneously after 3 minutes. The patient's blood sugar, serum electrolytes, and arterial blood gas analysis were normal immediately after the event. She remained hemodynamically stable; however, the surgery was postponed after communication and discussion with the surgeon. Postoperatively, there was no evidence of postictal phase, and serum electrolytes and magnetic resonance imaging of the brain were normal. The patient had an uneventful recovery. However, electroencephalogram showed that hyperventilation stimulation test induced isolated epileptiform spikes over O1, suggesting a potential paroxysmal disorder over the left occipital area. This report is on a rare complication likely caused by fentanyl or lidocaine, which suggests that these drugs should be used cautiously in children whose clinical epileptic activities have been verified or are strongly suspected.
authors.affiliation: Department of Anesthesiology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC; Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Xhang-Xian
authors.initials: XX
authors.lastname: Hsieh
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Yung-Chi
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.affiliation: Department of Neurology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Go-Shine
authors.initials: GS
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Shinn-Long
authors.initials: SL
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Zhi-Fu
authors.initials: ZF
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: anes2yeh@gmail.com.
authors.forename: Chun-Chang
authors.initials: CC
authors.lastname: Yeh
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002648:Child; D004830:Epilepsy, Tonic-Clonic / Q000139:chemically induced*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl
keywords: anesthesia; children; fentanyl; lidocaine; seizures