Propofol-induced seizure-like phenomena

Hickey, Kenneth S; Martín, David; Chuidian, Francis X.

doi:10.1016/j.jemermed.2005.05.009

Cited by 28 publications

(24 citation statements)

References 27 publications

(28 reference statements)

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“…Although select reports suggest an increase in seizure-like activity with propofol administration (41), our data further validate the safety and efficacy of propofol in this population and reinforce its role in the treatment of AWS in subjects resistant to other sedative-hypnotics.…”

Section: Discussionsupporting

confidence: 77%

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

158

164

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Objective-Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. Design-Retrospective cohort study.Setting-Inner-city municipal hospital.Patients-Subjects admitted to the medical ICU solely for the treatment of severe alcohol withdrawal. Interventions-Institution of guidelines emphasizing escalating doses of diazepam in combination with phenobarbital.Measurements and Main Results-Preguideline (n = 54) all subjects were treated with intermittent boluses of diazepam with an average total and maximal individual dose of 248 mg and 32 mg, respectively; 17% were treated with phenobarbital. Forty-seven percent required intubation due to inability to achieve adequate sedation and need for constant infusion of sedative-hypnotics. Intubated subjects had longer length of stay (5.6 vs. 3.4 days; p = .09) and higher incidence of nosocomial pneumonia (42 vs. 21% p = .08). Postguideline (n = 41) there were increases in maximum individual dose of diazepam (32 vs. 86 mg; p = .001), total amount of diazepam (248 vs. 562 mg; p = .001), and phenobarbital use (17 vs. 58%; p = .01). This was associated with a reduction in the need for mechanical ventilation (47 vs. 22%; p = .008), with trends toward reductions in ICU length of stay and nosocomial pneumonia.Conclusions-Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.

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Section: Discussionsupporting

confidence: 77%

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

158

164

View full text Add to dashboard Cite

show abstract

“…Fentanyl [19,20] and sevoflurane [21] may cause neurological complications but as far as we are aware, association with opisthotonus and myoclonus has not been described. In contrast, propofol has frequently been reported to cause this movement disorder [1,2,4,[6][7][8]. Seizure-like phenomena associated with propofol remain the likely cause after excluding other possibilities.…”

Section: Discussionmentioning

confidence: 99%

“…It is also commonly used as a sedative for surgical procedures and in the Intensive Care Unit (ICU). Although propofol has been used as an anticonvulsant, there have been reports of seizure-like phenomena associated with its administration [1][2][3][4][5][6][7][8]. This neurological side effect is usually short lived, but in some patients it may persist for weeks [5].…”

mentioning

confidence: 99%

Prolonged myoclonus after a single bolus dose of propofol

Tam

Irwin

Tse³

et al. 2009

Anaesthesia

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“…In the absence of EEG-diagnosed seizures, we must consider that the patient's neurologic findings may have been secondary to SLP after the administration of propofol and remifentanil. Numerous case reports, reviews, and retrospective studies have described abnormal neuromuscular events, including opisthotonos, oculogyric crisis, dystonia, myoclonus, choreoathetosis, and seizures, associated with propofol administration [6]. SLP have been reported in neonates [7], adults [8], and the elderly [6,9], sometimes within hours of propofol use and as long as 5 days after its administration.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous case reports, reviews, and retrospective studies have described abnormal neuromuscular events, including opisthotonos, oculogyric crisis, dystonia, myoclonus, choreoathetosis, and seizures, associated with propofol administration [6]. SLP have been reported in neonates [7], adults [8], and the elderly [6,9], sometimes within hours of propofol use and as long as 5 days after its administration. SLP tend to occur during changes in propofol blood levels, or more precisely, during changes in propofol levels in brain tissue.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia-related status epilepticus after fiber optic colonoscopy in a child

Shu

2015

ScienceOpen Research

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A healthy, 8-year-old girl with a history of hematochezia underwent an uneventful fiber optic colonoscopy with propofol anesthesia. During the postoperative recovery period, she experienced acute-onset muscle rigidity, loss of consciousness, apnea, hypoxia, and hyperthermia. She was administered cardiopulmonary resuscitation and was treated with naloxone, mannitol, and midazolam. She regained consciousness after 14 hours. She underwent cerebral function rehabilitation and was discharged in 1 month without obvious neurologic sequelae. This case illustrates that propofol may affect the developing brain differently from the adult brain. Propofol-induced seizures can lead to life-threatening status epilepticus in children. Immediate diagnosis and effective treatment are essential.

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Propofol-induced seizure-like phenomena

Cited by 28 publications

References 27 publications

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Prolonged myoclonus after a single bolus dose of propofol

Anesthesia-related status epilepticus after fiber optic colonoscopy in a child

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