Objective:

Background: Acute dystonic reactions (ADR) are well known adverse effects of dopamine receptor blocking agents, as antipsychotics or anti-emetics. Propofol-induced ADR, albeit yet described, is a rarer occurrence.

Methods:

Results: Case report: A healthy 23-years-old woman underwent orthopedic surgery due to trimalleolar fracture of the right leg. The procedure was performed under general anesthesia with propofol, fentanyl, rucoronium and midazolam. For pain control paracetamol and dexamethasone were given. After the procedure the patients recovered from anesthesia and was fully awake. No metoclopramide or ondaserton were administered. 24 hours latter, the patients presented abnormal cervical postures with retrocollis and left torticollis and a mouth closure dystonia. She had a left upper limb dystonia, with external rotation, abduction and hyperextention of the fingers. She also presented repeated crises of mild opisthotonus. During the episode speech was impaired due to craniofacial dystonia but she remain awake and consciousness was preserved. Vital signs were normal. She was diagnosed with ADR due to Acute dystonic reactions (ADR) are well known adverse effects of dopamine receptor blocking agents, as antipsychotics or anti-emetics. Propofol-induced ADR, albeit yet described, is a rarer occurrence.propofol and she was given 5 mg of intravenous diazepam and 2.5 mg of intravenous Biperiden with resolution of the dystonic crisis. Eight hours latter she present again a mild cervical dystonia with retrocollis which was successfully treated with a single dose of 2 mg of intravenous Biperiden. She was discharged two days latter and revaluated two at one month, without any other episode of dystonic postures and without alterations at neutologic examination.

Conclusions: Neuroexcitatory reactions secondary to propofol have been described: dystonia, myoclonus, generalized tonic-clonic seizures, exacerbation or resolution of pre-existing movement disorders. The fact that they appear especially during inducing or emergente of anesthesia, suggest that a change in cerebral levels of propofol may be the cause. As propofol is assumed to cause an imbalance between inhibitory and excitatory neurotramistters, favouring an increase in excitatory cholinergic output. This also explain the efficacy of the treatment with anticholinergic agents.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/propofol-induced-acute-dystonic-reaction-after-orthopedic-surgery-in-a-young-healthy-woman/