Thiopenthal for Propofol Related Extrapyramidal Movements: Case Report (original) (raw)
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Acta Scientific Medical Sciences, 2020
Propofol is a short-acting, lipophilic anesthetic. Intravenous propofol is the drug of choice for induction of anesthesia. Abnormal muscle movements, abnormal posturing and convulsions associated with the usage of propofol happen to be reported. The spinal cord plays an important role in modulating anesthetic-induced suppression of nociceptive transmission. Recent studies showed that propofol potentiates the inhibitory transmitter's glycine and 3~-aminobutyric acid (GABA) which enhance spinal inhibition during anesthesia. In this case report a 40-year-old male had seizures shortly after receiving epidural steroid injection given under anesthesia induced by propofol and fentanyl. Serum prolactin levels were found to be elevated. CT brain, CT spine and MR imaging of the brain were negative for any suggestive findings of epilepsy.
Spontaneous movement after injection of propofol
Anaesthesia, 1996
Spontaneous movement following injection of propofol at induction was studied in 303 patients. Two hundred patients were Caucasians and 103 were Asians. In a pilot study carried out prior to the main study, 26% of the Asians moved at induction as compared with 6% ofthe Cuucasians. The patients were studied in relation to a number ofvariables; age, sex, weight, height, race, smokerlnon smoker, oegetarianlnon vegetarian, alcohol consumption, premedication, use of fentanyl at induction and dose ofpropofol. When race was included as the sole variable there was a marginal but not significant difference between the two groups in terms of movement (p = 0.06). However, when the other recorded variables were taken into account, race was not included as a predictor of whether or not the patient moved. The best model,for predicting whether the patients moved or not combines the tlariables weight and dose ojpropofol. Patients were more likely to move i f they were lighter and the dose ofpropofol used at induction was higher.
Severe neuroexcitatory symptoms after anaesthesia – with focus on propofol anaesthesia
Acta Anaesthesiologica Scandinavica, 2000
Delayed neuroexcitatory symptoms after an uneventful anaesthesia are uncommon, although described in many reports. We want to report on two cases. The first patient developed muscle hypertonicity, jerky movements and unconsciousness after an uneventful anaesthesia with propofol, and later the same thing happened after anaesthesia with thiopentone. The second patient developed similar symptoms after an uneventful anaesthesia with propofol, but she never recovered completely after this and is now severely disabled. A search of the literature and the Swedish adverse drug reactions register revealed many similar cases. In both our patients the causal relationship between propofol and the neuroexcitatory symptoms remains uncertain, but we want to alert readers about this possible adverse reaction.
Rare Side Effects of Propofol Administration-Case Report and a Brief Literature Review
Journal of Pharmacy and Pharmacology 5 (2017) 807-811, 2017
Introduction: Propofol is an intravenous general anesthetic and sedation drug for use in the induction and maintenance of anesthesia or sedation. It is included in WHO Model List of Essential medicines and approved by the FDA (food and drug administration) in 1989. The side effects of Propofol have been studied widely in the last 25 years. They can be easily managed and that is why Propofol has become a first choice drug for the most of the anesthesiologists worldwide. This paper presents a case report of Propofol induced pulmonary edema and also a review of some of the rarest and unusual manifestations of Propofol side effects. Some of them are urine discoloration, tissue necrosis, rhabdomyolysis and postoperative pancreatitis. Methods and materials: A case summary of 18-years old woman with unusual postoperative pulmonary reaction was considered along with other documented cases. Several full-text articles were briefly analyzed for estimating the role of Propofol for a number of strange and potentially life threatening conditions. Results: Despite the low incidence rate, the presented case could be determined as a pulmonary edema due to its clinical features. Furthermore, rare drug reactions such as rhabdomyolysis, tissue necrosis, postoperative pancreatitis etc. may remain unrecognized and create diagnostic and therapeutic issues. Conclusions: Although the officially reported dangerous reaction, Propofol remains one of the best hypnotic and sedative agents. The better knowledge of the full list of drug reactions considered as rare and very rare is a guarantee of an adequate and a better therapeutic behavior.
Intraoperative refractory status epilepticus caused by propofol -a case report
Korean Journal of Anesthesiology, 2020
Background: Status epilepticus, when continued despite the administration of two antiepileptic drugs, is called refractory status epilepticus (RSE). The seizure-like phenomenon due to propofol is widely reported in the literature. However, RSE caused by propofol is rare and is a diagnostic dilemma. Case: A 44-year-old male patient presented with RSE during the intraoperative period and was under general anesthesia on propofol infusion. The seizure was resistant to benzodiazepines and phenytoin. Thereafter, the seizure subsided after the discontinuation of propofol infusion, and the patient was shifted to fentanyl and dexmedetomidine infusion for the maintenance of anesthesia. The postoperative follow-up was uneventful. Conclusions: This article focuses on the management of intractable intraoperative seizure and highlights the need for the exploration of seizure characteristics caused by propofol.
An Update on Clinical Concepts of Propofol
Journal of Evolution of medical and Dental Sciences, 2014
Propofol is an intravenous anaesthetic agent. Used as an induction agent it has replaced sodium thiopentone to a large extent. Apart from induction Propofol is used for maintenance of anaesthesia, intravenous sedation and as infusion in mechanically ventilated patients. Its faster and clear recovery has made it a drug of choice in day care cases. Propofol is cardiorespiratory depressant drug.It also lowers intracranial pressure and the laryngeal-pharyngeal reflexes. The properties of Propofol has made it a widely accepted anaesthetic agent. Wide application and easy availability has put the person using it at the risk of drug abuse. This article has focused on the
Propofol and Seizure-Like Activity
Bagcilar Medical Bulletin, 2018
In this study, seizure-like activity, injection pain, and the presence of dreams after propofol injection were assessed. Material and Method: One hundred women scheduled for obstetric and gynecologic procedures were evaluated. Patients were anesthetized with 1 mg/kg propofol. Seizure-like activity was described as "only left arm. " "started from left arm and involved whole body, " or "face only, " etc. The intensity of seizure-like activity (a brief and involuntary twitching of a muscle or a group of muscles) (SLA) was graded as 0=no SLA, 1=mild SLA-Local Group (only mild fasciculation involving face and/or distal upper and/or lower extremity, focal, or involving a part of the body) and 2=severe SLA-Generalized Group (marked movements involving limbs or trunk, generalized to the whole body). Operation time, additional doses of anesthetic given, time to eye-opening, the presence of dreams, injection-induced pain, and if present, seizure-like activity descriptions were analyzed. Statistical analysis: Baseline characteristics were described with mean, standard deviation, rate, and frequency. The distribution of variables was controlled with Kolmogorov Smirnov test. Quantitative data were compared with ANOVA (Tukey), independent sample t test and Mann Whitney U test. Qualitative data were analyzed using Chi-square test and Fisher test. Statistical analysis was performed using SPSS 21.0 software. A value of p<0.05 was considered significant. Results: The patients in the generalized seizure-like activity group were statistically significantly younger than those in the group with no seizures. Intrinsically, the additional dose in the generalized group was lower than in the group with no seizures and the localized seizure group. In the localized seizure group, there was statistically significant lower injection-induced pain compared to the no-seizure group. Conclusion: Seizure-like activity could be related with the patients' age.
A comparative study between propofol and etomidate in patients under general anesthesia
Brazilian Journal of Anesthesiology (English Edition), 2016
Background and objectives: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. Methods: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. Conclusions: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.