Introduction: Propofol is an anesthetic agent commonly used in emergency department (ED) procedural sedation. It is often preferred in orthopedic procedures because of its muscle-relaxing properties. Rarely, however, it can induce agitation and muscle hypertonicity.
\nCase Report: A 58-year-old man presented to the ED with a left ankle fracture-dislocation. Propofol was used to facilitate procedural sedation, but the patient became mildly agitated. Ketamine was used to achieve full induction, after which propofol was used again to facilitate muscle relaxation. Near the end of the procedure, the patient had opisthotonos and masseter spasm requiring bag-valve-mask ventilation and subsequent intubation. This reaction was ultimately attributed to adverse effects of the propofol.
\nConclusion: While propofol is generally well tolerated, it can potentially cause agitation, hypertonicity, and other side effects such as muscle spasms and seizure-like activity. Acknowledging and preparing for these risks can potentially improve patient outcomes.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"propofol"},{"word":"adverse event"},{"word":"excitotoxicity"},{"word":"opisthotonos"},{"word":"case report"},{"word":"agigtation"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6gd8q181","frozenauthors":[{"first_name":"Amit","middle_name":"S","last_name":"Padaki","name_suffix":"","institution":"Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas","department":""},{"first_name":"Prabhdeep","middle_name":"","last_name":"Uppal","name_suffix":"","institution":"Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware","department":""},{"first_name":"Michael","middle_name":"","last_name":"Perza","name_suffix":"","institution":"Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware","department":""}],"date_submitted":"2024-05-31T09:47:55.422000-05:00","date_accepted":"2024-09-24T11:43:38.784000-05:00","date_published":"2024-11-02T23:35:00-05:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/21283/galley/30162/download/"}]}