Perioperative Care of Infants and Children With Epilepsy or an Associated Seizure Disorder: A Focused Educational Review

A bstract A seizure disorder is one of the most common comorbid neurologic conditions that may be present in children. Providing perioperative care for these children may be required during elective, urgent, or emergent procedures unrelated to their primary seizure disorder or during surgical procedures aimed at lessening their seizure burden when pharmacologic therapy is ineffective. Regardless of the surgical procedure, perioperative care requires a staged approach with specific considerations during the preoperative evaluation, intraoperative care, and the postoperative period related to the primary seizure disorder or other associated comorbid conditions. This educational review outlines the perioperative care of infants and children with an underlying seizure disorder with a focus on preoperative preparation including perioperative dosing of anti-epileptic drugs, intraoperative care including the impact of commonly administered anesthetic agents on the seizure foci, choice of intraoperative medications and neuromuscular blocking agents, as well as a review of issues that may be encountered during postoperative care including strategies for pain management.