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REFERENCES 1. Murphy CG, Winter DC, Bouchier‑Hayes DJ. Tourniquet injuries: Pathogenesis and modalities for attenuation. Acta Orthop Belg 2005;71:635‑45. 2. Sapega AA, Heppenstall RB, Chance B, Park YS, Sokolow D. Optimizing tourniquet application and release times in extremity surgery. J Bone Joint Surg Am 1985;67:303‑14. 3. Horlocker TT, Hebl JR, Gali B, Jankowski CJ, Burkle CM, Berry DJ, et al. Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty. Anesth Analg 2006;102:950‑5. 4. Girardis M, Milesi S, Donato S, Raffaeli M, Spasiano A, Antonutto G. The hemodynamic and metabolic effects of tourniquet application during knee surgery. Anesth Analg 2000;91:727‑31. 5. Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg 2001;9:345‑51. 6. Horlocker TT, Wedel DJ. Anaesthesia for Orthopaedic surgery. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anesthesia. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 1338. Access this article online Quick response code Website: www.ijaweb.org
DOI: 10.4103/0019-5049.130868
Anaesthetic management in a patient with Lennox‑Gastaut syndrome Sir, Lennox‑Gastaut syndrome (LGS), is an age specific childhood epileptic encephalopathy characterised by triad of multiple and frequent epileptic seizures resistant to anti‑epileptic drugs, a characteristic electroencephalogram (EEG), psychomotor delay and behaviour disorder.[1] It occurs between 2 and 8 years of age. Diagnosis requires assessment of both clinical and EEG features, to distinguish LGS from other childhood epilepsy syndromes. “Drop attacks” are common resulting in recurrent injury. About 60% of children progress to status epilepticus. Management options include anti‑epileptic drugs, ketogenic 238
diet, surgery (corpus callostomy) and vagus nerve stimulation. A 7‑year‑old (21 kg) patient was brought to the emergency room with fracture of distal radius and ulna. A fixation was planned. The parents gave a history of LGS, indicating that she had multiple seizures in a day. The fracture was due to a fall during a “drop attack.” Her current anti‑epileptic medications included valproic acid and lamotrigine 3 times a day. The morning dose of the drugs had been already administered to the patient. Previous investigations showed an unremarkable magnetic resonance imaging brain, biotinidase deficiency, and a positive 2,4‑dinitrophenylhydrazine test. All other metabolic tests and routine lab investigations were normal. The EEG showed a frequent paroxysmal spike and wave discharges of
REFERENCES 1. Murphy CG, Winter DC, Bouchier‑Hayes DJ. Tourniquet injuries: Pathogenesis and modalities for attenuation. Acta Orthop Belg 2005;71:635‑45. 2. Sapega AA, Heppenstall RB, Chance B, Park YS, Sokolow D. Optimizing tourniquet application and release times in extremity surgery. J Bone Joint Surg Am 1985;67:303‑14. 3. Horlocker TT, Hebl JR, Gali B, Jankowski CJ, Burkle CM, Berry DJ, et al. Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty. Anesth Analg 2006;102:950‑5. 4. Girardis M, Milesi S, Donato S, Raffaeli M, Spasiano A, Antonutto G. The hemodynamic and metabolic effects of tourniquet application during knee surgery. Anesth Analg 2000;91:727‑31. 5. Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg 2001;9:345‑51. 6. Horlocker TT, Wedel DJ. Anaesthesia for Orthopaedic surgery. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anesthesia. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 1338. Access this article online Quick response code Website: www.ijaweb.org
DOI: 10.4103/0019-5049.130868
Anaesthetic management in a patient with Lennox‑Gastaut syndrome Sir, Lennox‑Gastaut syndrome (LGS), is an age specific childhood epileptic encephalopathy characterised by triad of multiple and frequent epileptic seizures resistant to anti‑epileptic drugs, a characteristic electroencephalogram (EEG), psychomotor delay and behaviour disorder.[1] It occurs between 2 and 8 years of age. Diagnosis requires assessment of both clinical and EEG features, to distinguish LGS from other childhood epilepsy syndromes. “Drop attacks” are common resulting in recurrent injury. About 60% of children progress to status epilepticus. Management options include anti‑epileptic drugs, ketogenic 238
diet, surgery (corpus callostomy) and vagus nerve stimulation. A 7‑year‑old (21 kg) patient was brought to the emergency room with fracture of distal radius and ulna. A fixation was planned. The parents gave a history of LGS, indicating that she had multiple seizures in a day. The fracture was due to a fall during a “drop attack.” Her current anti‑epileptic medications included valproic acid and lamotrigine 3 times a day. The morning dose of the drugs had been already administered to the patient. Previous investigations showed an unremarkable magnetic resonance imaging brain, biotinidase deficiency, and a positive 2,4‑dinitrophenylhydrazine test. All other metabolic tests and routine lab investigations were normal. The EEG showed a frequent paroxysmal spike and wave discharges of
