Propofol Related Abnormal Movements: A case report
Ali Kendal Oğuz, Yunus Emre Tunçdemir, Hilmi Demirki·ran
Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University, van, Turkey
INTRODUCTION Propofol is an intravenous anesthetic agent commonly used for general anesthesia and sedation. Although it is an antiepileptic drug, it may cause seizure-like myoclonic contractions. We presented ın this case a patient with myoclonic contractions during intravenous (IV) Propofol induction. CASE A 46-year-old female patient was prepared for elective surgery to Multinodular goiter. Her physical examination was normal and she was evaluated as ASA II with Mallampati I. Biochemistry test values were normal. After premedication with midazolam 0,03 mg / kg iv, standard ASA monitoring was performed to the patient in to the operating room. The patient's vital signs: non-invasive arterial pressure: 129/85 mmHg, pulse: 90 / min, SpO2: 96 cmH2O were measured. The patient was preoxygenated at 6 L / min with 100% oxygen. In anesthesia induction; Propofol infusion was terminated in the patient who had sudden sputtering contractions during the administration of propofol 2 mg / kg iv after administering fentanyl 2 mg / kg iv. The patient, who was stopped contractions with thiopental 4 mg / kg IV, was intubated after curarization with rocuronium 0.5 mg / kg iv infusion. In the patient who underwent 1 MAC Sevoflurane in the maintenance of anesthesia, the surgery procedure was performed. After extubation, the patient's vital signs were stable.
Several mechanisms are responsible for the neuroexitator symptoms associated with propofol. Among these mechanisms; the effect on the inhibitory and excitatory neurons, the strychnine-like effect on glycinegic are prominent. In a similar study, Demirkıran et al. Emphasized that thiopental-suppression of propofol-induced myoclonic contractions was more effective than Midazolam In this case, as soon as the side effects were noticed, it was terminated with Thiopental. CONCLUSION When using propofol, to be seizure-like contractions must be predicted; The protection of the airway and the prevention of contractions precaution should be taken.