Postoperative seizures can have physiologic, pharmacologic, and pathologic causes. This chapter presents a case study of a 56-year-old female presented for resection of a 2 cm by 2.5 cm mass in the right temporal lobe. The patient was brought to the operating room for a scheduled resection of the tumor under general endotracheal anesthesia. Midazolam was administered and the seizure was terminated, but she was now lethargic and combative. Citrate is added to stored blood to bind calcium and prevent coagulation of the stored blood. Some advocate a remifentanil infusion be used intraoperatively as it can provide a smooth emergence and because of its short half life a quick return to neurologic baseline. Immediate termination of the seizure should be followed by a rapid assessment of reversible physiologic causes and then amore extensive differential to identify the underlying source.