Intraoperative electrocorticography during awake craniotomy reveals continuous epileptiform discharges after cortical stimulation mapping. The MOST appropriate pharmacological intervention that provides rapid seizure termination without compromising cortical mapping in the immediate window is:

• A IV thiopentone 100 mg to produce burst suppression
• B IV propofol 40 mg slow bolus
• C IV lorazepam 4 mg to terminate seizure activity
• D Irrigation of the cortex with cold Ringer's lactate solution ✓

Explanation

Direct cortical irrigation with cold (4°C) Ringer's lactate or normal saline is the preferred method to terminate intraoperative seizures during awake craniotomy because it works rapidly, is localised, and does not impair neurological function needed for ongoing mapping. IV anticonvulsants (lorazepam, propofol, barbiturates) cause sedation and may compromise the patient's ability to cooperate for language/motor mapping for 30–60+ minutes. Cold irrigation terminates seizures via membrane stabilisation without systemic effects.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.