Home
|
Inbox
|
Search
|
View Abstract
Propofol Induced Dystonia: A Rare Drug Reaction
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6860 - Propofol Induced Dystonia: A Rare Drug Reaction
Author Block: M. Reddy1, A. Miller2, A. Scalzo3, S. Osmond2, C. Krausz4; 1Internal Medicine, St. Louis University School of Medicine, St. Louis, MO, United States, 2St. Louis University School of Medicine, St. Louis, MO, United States, 3Toxicology, St. Louis University School of Medicine, St. Louis, MO, United States, 4Emergency Medicine, St. Louis University School of Medicine, St. Louis, MO, United States.
Introduction:
Propofol induced dystonia is a rare anesthetic reaction that has been minimally described in the literature. We report a case of a 26-year old female who developed propofol induced dystonia.
Case:
A 32-year-old female with recurrent lower respiratory tract infections, possible pancreatic insufficiency and recurrent right shoulder dislocations presented with right-sided shoulder dislocation and gastro-jenunal tube dislodgement. The patient was unable to tolerate a shoulder reduction or tube replacement without sedation so she received propofol 90 mcg, fentanyl 200 mcg, and morphine 4 mg. The patient had received fentanyl and morphine during prior hospitalizations with no adverse events. A closed reduction of the right shoulder was performed by the proceduralist, followed by replacement of the gastro-jejunal tube. Minutes later, the patient was noted to be unresponsive with rhythmic clonic-type movement, clenched teeth, and extended neck posturing. A physical exam showed no fever, tachycardia, rigidity, or hyperreflexia and a computed tomography scan of her brain was unremarkable. The patient was loaded with Levetiracetam and Lorazepam with resolution of symptoms. The patient was advised to avoid propofol during future hospitalizations.
Discussion:
The administration of propofol has been associated with abnormal movement and seizure-like activity. Neuromuscular coordination is thought to be mediated by the balance between inhibitory dopamine receptors and excitatory cholinergic receptors in the basal ganglia Our literature search suggests that dystonic reactions are caused by an imbalance of cholinergic-dopaminergic neurotransmitters. It is posited that propofol may cause dystonia by increases in excitatory cholinergic activity. This case is of significance as propofol is a widely used sedative in the intensive care unit. It is important for the clinician and proceduralist to be aware of this rare side effect of a widely used therapy.
Author Block: M. Reddy1, A. Miller2, A. Scalzo3, S. Osmond2, C. Krausz4; 1Internal Medicine, St. Louis University School of Medicine, St. Louis, MO, United States, 2St. Louis University School of Medicine, St. Louis, MO, United States, 3Toxicology, St. Louis University School of Medicine, St. Louis, MO, United States, 4Emergency Medicine, St. Louis University School of Medicine, St. Louis, MO, United States.
Introduction:
Propofol induced dystonia is a rare anesthetic reaction that has been minimally described in the literature. We report a case of a 26-year old female who developed propofol induced dystonia.
Case:
A 32-year-old female with recurrent lower respiratory tract infections, possible pancreatic insufficiency and recurrent right shoulder dislocations presented with right-sided shoulder dislocation and gastro-jenunal tube dislodgement. The patient was unable to tolerate a shoulder reduction or tube replacement without sedation so she received propofol 90 mcg, fentanyl 200 mcg, and morphine 4 mg. The patient had received fentanyl and morphine during prior hospitalizations with no adverse events. A closed reduction of the right shoulder was performed by the proceduralist, followed by replacement of the gastro-jejunal tube. Minutes later, the patient was noted to be unresponsive with rhythmic clonic-type movement, clenched teeth, and extended neck posturing. A physical exam showed no fever, tachycardia, rigidity, or hyperreflexia and a computed tomography scan of her brain was unremarkable. The patient was loaded with Levetiracetam and Lorazepam with resolution of symptoms. The patient was advised to avoid propofol during future hospitalizations.
Discussion:
The administration of propofol has been associated with abnormal movement and seizure-like activity. Neuromuscular coordination is thought to be mediated by the balance between inhibitory dopamine receptors and excitatory cholinergic receptors in the basal ganglia Our literature search suggests that dystonic reactions are caused by an imbalance of cholinergic-dopaminergic neurotransmitters. It is posited that propofol may cause dystonia by increases in excitatory cholinergic activity. This case is of significance as propofol is a widely used sedative in the intensive care unit. It is important for the clinician and proceduralist to be aware of this rare side effect of a widely used therapy.
|
Home
|
Inbox
|
Search
|