Akademik Veri Yönetim Sistemi
International Aegean Symposium, İzmir, Türkiye, 12 - 13 Mart 2021, ss.71-72
INTRODUCTION
Propofol frequently used in day-case surgeries. Although it used to treat status epilepticus because of its anticonvulsant property, propofol was reported to cause epileptiform convulsions in the literature.
CASE
The 23-year-old male patient, who does not have a known systemic disease, has epileptic seizures after 40 mg articaine injection for tooth extraction anesthesia two months ago. According to the common suggestion of related services, the operation was suggested to be carried out under general anesthesia. Midazolam (1mg) was administered for premedication in the preoperative period. For induction, fentanyl (2 mcg/kg), propofol (2.5 mg/kg), and rocuronium (0.9 mcg/kg) were injected, and endotracheal intubation was applied to the patient. For maintenance, 50% oxygen/air mixture including 6% desflurane was administered. Intraoperative vital variables were normal during the operation. 2 minutes after extubating, the patient had a generalized tonic-clonic seizure. Due to the lack of response from IV 1 mg midazolam and 5 mg diazepam, phenytoin treatment was administered and the patient taken to the ICU. In the ICU, propofol infusion (3 mg/kg/hour) was administered 24 hours. No urgent pathological case was detected in the CT and MRI scans. On the first day of the ICU, the seizures continued; therefore, topiramate(300 mg), zonisamide (100 mg), and levetiracetam(2x500 mg) were ordered. On Day 2-3 seizures, degressively continued. On Day 4, the patient regained consciousness, and the seizures were taken under control; thus, the patient was taken to neurology service.
It should be noted that although propofol could be a part of the treatment for status epilepticus, it could also induce convulsions and epileptiform seizure-like phenomena. High doses of the medication reduce the influence on cortex and subcortex consequently generate an anticonvulsant effect. But, only inhibitory subcortex is influenced with low doses, excitability of cerebral cortex neurons increases and the convulsant effect emerges.
Keywords: Status Epilepticus, General Anesthesia, Propofol.