Remifentanil and seizures

Blair and Hill report an association between remifentanil administration and seizure-like activity in a 4-year-old child presenting for elective tonsillectomy (Blair & Hill. Anaesthesia 2000; 55: 501). The case was abandoned and he subsequently recovered. They mention that hypoglycaemia was 'unlikely', but this was in no way excluded because blood glucose was not measured in their patient. Effective management of adverse events hinges on rapid evaluation and correction of airway, breathing and circulatory disturbance (ABC), followed by management of neurological disability (such as seizure). Crucial to this is blood glucose analysis, and this should be considered a mandatory investigation [1]. During unexpected and perhaps challenging circumstances, the alphabet can help us – A, B, C and Don't Ever Forget Glucose.