Cardiovascular Journal of Africa: Vol 26 No 1 (January/February 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015 AFRICA e11
Case Report
An unusual cause of generalised seizure following
cardiac surgery: with bolus cefazolin administration
Kadir Ceviker, Ozcan Kocaturk, Deniz Demir
Abstract
Although some of the aetiological factors of seizure, such
as cerebral microemboli, cerebral oedema, hypoperfusion,
cerebral hypoxia and metabolic encephalopathy cannot
be completely controlled during cardiac surgery, cautious
management of all steps in the procedure may prevent the
administrative causes of seizure. Cefazolin, which is known
to be a proconvulsant agent, may be a suspected agent of
seizure complications in patients with renal insufficiency.
Surprisingly, intravenous bolus administration of cefazolin
may also trigger seizure in patients with normal renal func-
tion. In this case report, a complication of generalised seizure
after cardiac surgery with intravenous bolus administration
of cefazolin is described, along with a brief review of the
literature.
Keywords: cardiac surgery, cefazolin, adverse effect, seizure
Submitted 27/3/14, accepted 10/1/15
Cardiovasc J Afr 2015; 26: e11–e13
DOI: 10.5830/CVJA-2015-002
Neurological complications are a major cause of morbidity
and mortality during the immediate postoperative period
following cardiac surgery. Although ischaemic stroke has the
highest rate of incidence among neurological complications
(range between 2 and 6% among patients who have undergone
myocardial revascularisation), differing degrees of decrease in
the level of consciousness, a more or less evident deterioration
in neuropsychological function, and convulsive seizures may be
observed during the immediate postoperative period following
cardiac surgery.1
The exact rate of incidence of seizures after cardiac surgery is
not well studied and is reported in the literature as 0.5%. 2 Among
the aetiological factors of seizures, cerebral microemboli (50%),
cerebral oedema, hypoperfusion, cerebral hypoxia, metabolic
encephalopathy (6–30%), and the effects of pharmacological
agents used in anesthesia and during the peri- and postoperative
periods have been considered.1,2
In this report, we present a case of generalised seizure
in a coronary artery bypass surgery patient and analyse the
aetiological factors in the context of the literature.
Case report
A 57-year-old, 83-kg, 176-cmmale with a history of hypertension
was admitted for coronary artery bypass surgery. Surgery was
performed with the standard on-pump technique.
During extracorporeal circulation, his systolic blood pressure
was maintained between 50 and 70 mmHg; haemoglobin and
haematocrit levels were maintained above 8 g/dl and 27%,
respectively. Intra-operative heparinisation was managed
as standard procedure and the activated clotting time was
maintained above 480 seconds.
There was no calcified plaque that could have caused
embolism during surgery at the aortic cannulation and proximal
bypass sites, and care was taken to avoid embolism of air, lipid
and other particles. No extraneous blood was used during or
after the operation.
Total surgery, cardiopulmonary bypass and cross-clamp times
were 190, 76 and 43 minutes, respectively. Haemoglobin and
haematocrit levels were 12 g/dl and 34%, respectively, after the
operation.
Following an uneventful surgery, the patient was monitored in
the intensive care unit (ICU). Around three hours after surgery,
the patient was extubated without any surgical complication
and was in a haemodynamically stable situation. However, he
was observed by the ICU nurse to be ‘shaking all over’ during
respiratory exercise 11 hours after the surgery, which was
ameliorated through the management of anaesthesia. Sedation
was achieved by the administration of propofol, and muscle
relaxation was achieved with pancuronium bromide after the
patient was intubated.
On further questioning, it was revealed that the patient
had tonic stiffening followed by rhythmic myoclonic jerking
and upward deviation of the head and eyes. A review of
his medications revealed that the patient had received 1g of
cefazolin 30 minutes before the skin incision (pre-operatively),
1 g of cefazolin three hours after the first administration (peri-
Department of Cardiovascular Surgery, Süleyman Demirel
University, Isparta, Turkey
Kadir Ceviker, MD,
Department of Neurology, Harran University, Sanlıurfa,
Turkey
Ozcan Kocaturk, MD
Cardiovascular Surgery, Sanlıurfa Training and Research
Hospital, Sanlıurfa, Turkey
Deniz Demir, MD