50yo male for dental extraction

Background

• BMI 47
• OSA CPAP
• T2DM ozempic, HbA1C 8.7%, microvascular (peripheral neuropathy, nephropathy)
• “Seizure activity” 20 year hx, provoked by Valsalva maneouvre or irritant stimuli (e.g. BP cuff inflation, head in certain positions). EEGs show no epileptiform activity. Neurologists suggest it is not epilepsy.

Issues

• Magnesium sterate allergy (common incipient)
• Concerns around seizure activity and perioperative management

Discussion

• Excipient list in medications chosen by procedural anaesthetist will need to be checked
• Patient insistent that he wants a GA
• May have “seizure type” activity perioperatively. 

Plan

• Proceed to OT
• Manage any perioperative seizure-type activity as you usually would. Liaise with neurologist as needed.
• Check excipients in agents used.