Perioperative Blood Tests for a 13-Year-Old with Developmental Delay, Seizure Disorder, and Cataract
For this 13-year-old undergoing cataract surgery, obtain a complete blood count (CBC) with differential, basic metabolic panel (renal function), liver function tests, and glucose level preoperatively. 1, 2
Essential Baseline Laboratory Testing
The combination of developmental delay, seizure disorder, and need for general anesthesia necessitates specific preoperative laboratory evaluation:
- Complete blood count with differential is required to establish baseline hematologic values, particularly important given potential antiepileptic drug effects on blood counts 2, 3
- Renal function tests (BUN, creatinine) must be obtained as many antiepileptic medications can affect kidney function and fluid management will be critical perioperatively 2
- Liver function tests and bilirubin are essential since antiepileptic drugs commonly cause hepatic enzyme alterations 2
- Glucose level should be checked preoperatively, as children with developmental delay and mitochondrial concerns require careful glucose monitoring 4
Additional Testing Based on Clinical Context
- Coagulation studies (PT, aPTT, fibrinogen) should be obtained if the patient is on multiple antiepileptic medications, as certain drugs (particularly valproate) can affect coagulation 5, 3
- Antiepileptic drug levels of the patient's seizure medications should be measured to ensure therapeutic levels and optimize seizure control perioperatively 6
Risk Stratification Considerations
This patient falls into a higher-risk category despite cataract surgery being generally low-risk, due to:
- The seizure disorder requiring enhanced monitoring protocols 1
- Developmental delay necessitating careful anesthetic planning 1, 7
- Risk of perioperative seizures is 3.4% in patients with preexisting seizure disorders, with frequency directly related to baseline seizure control 6
Critical Perioperative Planning Requirements
- Multidisciplinary coordination between ophthalmology, anesthesia, and neurology must occur with specific protocols for seizure management including immediate availability of benzodiazepines (midazolam 0.1-0.2 mg/kg IV) 1
- Glucose-containing IV fluids should be used perioperatively, particularly if there is any concern for underlying metabolic disorder given the developmental delay 4
- Continuous monitoring with pulse oximetry and capnography is essential, as capnography detects respiratory depression several minutes before pulse oximetry alone 1
Common Pitfalls to Avoid
- Do not assume "routine" preoperative testing is unnecessary—the combination of developmental delay and seizure disorder mandates baseline laboratory assessment 2, 3
- Ensure antiepileptic medications are continued through the perioperative period without missed doses, as medication interruption significantly increases perioperative seizure risk 6
- Patients with frequent baseline seizures (more than monthly) are at highest risk for perioperative seizures regardless of anesthetic technique used 6