Menşure KAYA, İlker YİĞİT, Müge CEYLAN, Hamit Erdal ESKİÇIRAK, Nihal KADIOĞULLARI

PROPOFOLE BAĞLI NÖBET BENZERİ AKTİVİTE: OLGU SUNUMU

Propofol kısa etki süresi nedeniyle anestezi ve sedasyon için yaygın olarak kullanılan bir ilaçtır. Antikonvülzan olarak status epileptkus tedavisinde önerilmekle birlikte, epileptik hastalık ve kafa travması öyküsü olan hastalarda özellikle de düşük dozlarda kullanıldığında nöbet benzeri aktivite oluşturduğu bildirilmiştir. Sağ humerus proksimalinde basit kist nedeniyle biyopsi işlemi planlanan 27 yaşında kadın hastaya propofol 3 mg kg1 iv verildikten sonra bir dakika içinde hem alt hem üst ekstremitelerde tonik klonik tarzda kasılmalar gözlendi. Bu kasılmalar tiyopental uygulanarak kontrol altına alındı. Anestezi uygulamaları için çok sık kullanılan propofolün tamamen sağlıklı bireylerde ve yüksek dozda kullanıldığında da nöbet benzeri aktivite oluşturabileceğine dikkat çekmek ve tartışmak istedik

Anahtar Kelimeler:

Genel anestezi, propofol, tonik klonik konvülziyon

Propofol Induced Seizure Like Activity: A Case Report

Propofol is a widely used drug because of short acting time for anesthesia and sedation. Although ıt has been suggested as a anticonvulsant in treatment of status epilepticus, it has been also reported to induce seizure like activity in patients with epilepsia and head injury especially in low dose. A few minutes after giving propofol 3 mg kg-1 iv to a 27 years old female patient scheduled for biopsy of a simple cyst in the right proximal humerus, tonicclonic convulsions were observed both in the upper and lower extremities. Convulsions were managed by administering thiopental. We want to discuss and point to that propofol which is frequently used for anesthetic procedures may induce seizure like activity in exactly healty people.

Keywords:

General anesthesia, propofol, tonic clonic convulsion,

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1. Sanna E, Mascia MP, Klein RL, Whiting PJ, Biggio G, Harris RA. Actions of the general anesthetic propofol on recombinant human GABA A receptors: influence of receptor subunits. J Pharmacol Exp Ther 1995; 274(1): 353-60.
2. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000;90(4): 963-9.
3. Nimmo GR, Mackenzie SJ, Grant IS. Hemodynamic and oxygen transport effects of propofol infusion in critically ill adults. Anesthesia 1994; 49(6): 485-9.
4. Tramer MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth 1997; 78(6): 642-51.
5. Wood PR, Browne GP, Pugh S. Propofol infusion for the treatment of status epilepticus. Lancet 1988; 1(8583): 480-1.
6. Yanny HF, Christmas D. Propofol infusions for status epilepticus. Anaesthesia 1988; 43(6): 514.
7. Karaaslan K, Gümüş E, Gülcü N, Altunrende B. Treatment of refractory generalized status epilepticus with propofol. [Jeneralize status epileptikusun propofol ile tedavisi.] Düzce Tıp Fakültesi Dergisi 2008; 10(3): 53-6.
8. Walder B, Tramer MR, Seeck M. Seizure-like phenomena and propofol. A systematic review. Neurology 2002; 58(9): 1327-32.
9. Friedman NL. Hiccups: a treatment review. Pharmacotherapy 1996; 16(6): 986-95.
10. Launois S, Bizec JL, Whitelaw WA, Cabane J, Derene JP. Hiccup in adults: an overview. Eur Respir J 1993; 6(4): 563-75.
11. Modica PA, Tempelhoff R, White PF. Pro-and anticonvulsant effects of anesthetics(part II). Anesth Analg 1990; 70(4): 433-44.
12. Schneider R, Reebye U, Choi C, Kalman D. Seizurelike activity and prolonged central nervous system side effects after intravenous sedation. J Oral Maxillofac Surg 2008; 66(6): 1277-82.
13. Webb MD. Seizure-like activity during fentanyl anesthesia. A case report. Anesth Prog 1990; 37(6): 306-307.
14. Fujımoto T, Nishiyama T, Hanaoka K. Seizure induced by a small dose of fentanyl. J Anesth 2003; 17(1): 55- 56.
15. Borgeat A. Propofol: pro- or anticonvulsant? Eur J Anaesthesiol Suppl 1997; 14: 17-20.
16. Islander G, Vinge E. Severe neuroexcitatory symptoms after anaesthesia- with focus on propofol anaesthesia. Acta Anaesthesiol Scand 2000; 44(2): 144-9.
17. Cochran D, Price W, Gwinnutt CL. Unilateral convulsion after induction of anesthesia with propofol: Br J Anaesth 1996; 76(4): 570-2.
18. Brooks DE. Propofol-induced movement disorders. Ann Emerg Med 2008; 51(1): 111-2.
19. Sneyd JR. Excitatory events associated with propofol anaesthesia: a review. J R Soc Med 1992; 85(5): 288- 91.
20. Yağar S, Kılıç M, Turan S, Özgök A. Propofol induced seizure like phenomena [Propofole bağlı nöbet benzeri tablo]. Türk Anest Rean Der Dergisi 2010; 38(6): 447- 50.
21. Ömür D, Oğuzalp H, Uyan B, Örs CH, Karaman HÖ. Propofol induced seizure like activity. [Propofolün neden olduğu nöbet benzeri aktivite]. Türk Anest Rean Der Dergisi 2011; 39(2): 95-9.