Opisthotonos following propofol: A nonepileptic perspective and treatment strategy

Ries, Craig R.; Scoates, Peter J.; Puil, E.

doi:10.1007/bf03009864

Cited by 49 publications

(29 citation statements)

References 47 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2 The myotonic and dystonic movements, muscular hypertonus, opisthotonus, and seizures may appear as late as five hours after administration. [2][3][4][5] Our patient did not show opisthotonus or any dystonic movements, which are two principal signs of propofol neuroexcitation. The delayed presentation, three hours after the single bolus of propofol, also makes the diagnosis of propofol neuroexcitation improbable.…”

Section: Differential Diagnosismentioning

confidence: 49%

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Roy

Fortier

2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo-oophorectomy under general anesthesia. She received a total of 500 µg of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 µg. The rest of the postoperative period was uneventful.

show abstract

Section: Differential Diagnosismentioning

confidence: 49%

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Roy

Fortier

2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…We can, however, take some comfort in the knowledge that they do appear to resolve completely with time. Ries et al 16 postulated that neuroexcitatory events associated with propofol may have a common mechanism, namely an enduring refractoriness of inhibitory pathways in the brainstem. It may be particularly relevant to this case, that an anticholinesterase agent (physostigmine) proved successful in.…”

Section: Discussionmentioning

confidence: 99%

“…17 In the event of encountering these phenomena, it has been recommended that therapy be aimed at potentiating the inhibitory neurotransmitters glycine and y-aminobutyric acid (GABA) using benzodiazepines, physostigmine, and chlormethiazole. 16 …”

Section: Discussionmentioning

confidence: 99%

Prolonged myoclonus and meningism following propofol

Hughes

Lyons

1995

Can J Anaesth

View full text Add to dashboard Cite

Accepted for publication 5th April, 1995. Propofol was introduced into clinical practice in 1986, and since then has been given to over 16 million patients worldwide (data provided by Zeneea formerly ICI Pharma). The incidence of adverse effects has been low and confined mainly to excitatory neurological manifestations. Increased use, however, has unveiled a broadening spectrum of such phenomena, and here we describe the fLrst case of meningism occurring in association with propofol administration.Case report A 15-yr-old boy, weighing 52 kg, presented for removal of dental wires under general anaesthesia. These had been inserted five weeks previously for fixation of a fractured mandible, and on that occasion anaesthesia (O2:N20: isoflurane following induction with thiopentone) had been uneventful. The patient had no previous medical history, and had not sustained a head injury or loss of consciousness when fracturing his mandible. There was no history of epilepsy, drug abuse or recent infections.The patient presented as a day case and was unpremedicated. On arrival in theatre intravenous access was established and 50 Isg of fentanyl were given. Monitoring consisted of non-invasive blood pressure measurement, ECG, and pulse oximetry. After pre-oxygenafion, anaesthesia was induced with propofol 175 nag, and this was not accompanied by excitatory phenomena or pain on injection. The dental wires were quickly removed (one minute), and no further anaesthetic agents were administered. On resumption of spontaneous ventilation the patient was brought to the recovery room where five minutes alter induction of anaesthesia he developed generalised myoclonic jerking. These spasmodic contractions were asynchronous in nature, involved the muscles of his arms, trunk and legs, and were exacerbated by attempts to rouse him. He remained unresponsive and was noted to have a marked disconjugate gaze and pupillary dilatation. This state persisted for 35 min and during this time temperature, blood pressure, heart rate, arterial blood gas, and blood glucose measurements were within normal limits. Then the patient regained conseiousness but there was no improvement in the myoclonus. Diazemuls, 5 mg/v, was administered with minimal effect on the myoclonic jerking.

show abstract

“…4 Propofol administration has been associated with excitatory phenomena in human, including opisthotonus, dystonia, and myoclonic seizure, which could be refractory to treatment. 19 Propofol exerts a strychnine-like effect on subcortical glycine receptors, leading to neuroexcitation. It also increases GABAergic inhibition to the thalamus, leading to thalamocortical oscillations.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic considerations in scoliosis patient with dopa-responsive dystonia or Segawa’s syndrome

Hasan

Leong

Chan

et al. 2017

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Segawa's syndrome or dopa-responsive dystonia is a rare hereditary disorder characterized by progressive dystonia of childhood onset, diurnal fluctuation of symptoms and complete or near complete alleviation of symptoms with administration of low-dose oral levodopa. From our literature search in PubMed, we found only three related publications: two on anesthesia for cesarean section and one on anesthesia for electroconvulsive therapy. We report our experience in providing anesthesia for corrective scoliosis surgery in two biological sisters with Segawa's syndrome. A review of the literature is also included.

show abstract

Opisthotonos following propofol: A nonepileptic perspective and treatment strategy

Cited by 49 publications

References 47 publications

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

Prolonged myoclonus and meningism following propofol

Anesthetic considerations in scoliosis patient with dopa-responsive dystonia or Segawa’s syndrome

Contact Info

Product

Resources

About