What are the causes of seizure post Coronary Artery Bypass Graft (CABG) surgery?

From the Guidelines

Post-CABG seizures are most likely caused by cerebral embolism, hypoperfusion during bypass, metabolic derangements, or medication effects, as suggested by the 2014 ESC/EACTS guidelines on myocardial revascularization 1. The causes of seizure post Coronary Artery Bypass Graft (CABG) surgery can be multifactorial, including:

• Cerebral embolism, which can occur during the surgical procedure, particularly during aortic cannulation, as mentioned in the 2014 ESC/EACTS guidelines on myocardial revascularization 1
• Hypoperfusion during bypass, which can lead to inadequate blood flow to the brain, resulting in ischemia and potentially seizures, as discussed in the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1
• Metabolic derangements, such as electrolyte imbalances, hypoglycemia, or hyperglycemia, which can contribute to seizure activity, as highlighted in the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1
• Medication effects, such as those related to anesthetics or other medications used during the surgical procedure, which can increase the risk of seizures, as mentioned in the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1 It is essential to note that the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery 1 and the 2014 ESC/EACTS guidelines on myocardial revascularization 1 provide valuable insights into the potential causes of post-CABG seizures, but the most recent and highest-quality study, the 2014 ESC/EACTS guidelines on myocardial revascularization 1, should be prioritized when determining the causes of post-CABG seizures. Some key points to consider when evaluating post-CABG seizures include:
• The importance of prompt evaluation and management, including securing the airway, ensuring adequate oxygenation, and stabilizing hemodynamics
• The need for urgent neurological consultation and neuroimaging (CT or MRI) to identify potential causes of seizures
• The potential benefits of continuous EEG monitoring for patients with persistent altered mental status
• The importance of correcting any electrolyte imbalances, hypoglycemia, or hyperglycemia, and maintaining normothermia to prevent further seizure activity.

From the Research

Causes of Seizure Post Coronary Artery Bypass Graft (CABG) Surgery

• The exact causes of seizure post CABG surgery are not explicitly stated in the provided studies, but possible causes can be inferred from the complications associated with CABG surgery 2.
• Postoperative complications of CABG surgery can result in significant morbidity and mortality, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability 2.
• Seizures can occur as a result of various factors, including acute and remote symptomatic seizures, which require simultaneous treatment of the underlying etiology 3.
• The management of seizures following a stroke, which can be a complication of CABG surgery, is a complex issue, and the optimal timing and type of antiepileptic drug (AED) treatment is still a controversial issue 4.

Risk Factors for Seizure Post CABG Surgery

• Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors 2.
• Patient characteristics, such as age, comorbidities, and previous stroke, can increase the risk of seizure post CABG surgery 4.
• Postoperative factors, such as hemodynamic instability, can also contribute to the risk of seizure post CABG surgery 2.

Diagnosis and Treatment of Seizure Post CABG Surgery

• The diagnosis of seizure post CABG surgery requires a comprehensive evaluation, including findings on examination, laboratory tests, and brain imaging 3.
• The treatment of seizure post CABG surgery depends on the underlying cause and may involve the use of antiepileptic drugs, such as benzodiazepines, fosphenytoin, or phenytoin 3, 5.
• The choice of antiepileptic drug and the duration of treatment should be individualized based on the patient's specific needs and circumstances 4, 5.