• Junbei Wu, Yin Fang, and Wenjie Jin.
• Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China.
• Medicine (Baltimore). 2020 Nov 20; 99 (47): e22470.

RationalePercutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for removing nucleus pulposus and achieving neural decompression via a posterolateral approach. PELD is known to have a very low rate of complications during the perioperative period. Although quite rare, seizures can occur in patients undergoing PELD.Patient ConcernsA 58-year-old man with severe low back pain underwent the PELD procedure under general anesthesia. During the recovery phase after general anesthesia, the patient developed a tonic-clonic seizure. Two additional episodes occurred subsequently.DiagnosesBilateral disc swelling indirectly supports the diagnosis of intracranial hypertension.InterventionsMidazolam and propofol were administered to control seizures. 1.0 g phenobarbital sodium was administered by intravenous injection. Ten milligrams of furosemide and 250 mL of mannitol (20%) were prescribed sequentially. Two hundred milligrams of hydrocortisone and an ice bag were used to protect the brain. Urapidil, metoprolol, and nicardipine were intermittently used to control his blood pressure. A sustained release of sodium valproate was administered and continued prophylactically for 4 weeks.OutcomesNo further seizures were recorded and the patient recovered well.LessonsWe conclude that total volume of fluid used for irrigation was considered a possible cause of seizure. This case illustrates the fact that irrigation should be performed cautiously in PELD procedure. And anesthesiologists should be familiar with the management strategies of perioperative acute seizures.

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