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    Anesthesia-related status epilepticus after fiber optic colonoscopy in a child

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        Abstract

        A healthy, 8-year-old girl with a history of hematochezia underwent an uneventful fiber optic colonoscopy with propofol anesthesia. During the postoperative recovery period, she experienced acute-onset muscle rigidity, loss of consciousness, apnea, hypoxia, and hyperthermia. She was administered cardiopulmonary resuscitation and was treated with naloxone, mannitol, and midazolam. She regained consciousness after 14 hours. She underwent cerebral function rehabilitation and was discharged in 1 month without obvious neurologic sequelae. This case illustrates that propofol may affect the developing brain differently from the adult brain. Propofol-induced seizures can lead to life-threatening status epilepticus in children. Immediate diagnosis and effective treatment are essential.

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        Most cited references 14

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        Effect of propofol on seizure-like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties.

        There is an ongoing debate as to whether propofol exhibits pro- or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure-like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure-like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23/25 children), and suppression of pre-existing theta rhythms (11/16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike-wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike-wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike-wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time-dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative-hypnotic agent with anticonvulsant properties as shown by depression of spike-wave patterns in children with epilepsy and by the absence of seizure-like phenomena of epileptic origin.
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          Propofol treatment in adult refractory status epilepticus. Mortality risk and outcome.

          To retrospectively study effect and safety of propofol treatment in adult refractory generalised tonic clonic status epilepticus.
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            Unexpected neurological sequelae following propofol anesthesia in infants: Three case reports.

            Propofol is a widely used hypnotic agent for induction and maintenance of pediatric anesthesia with a well known safety profile. Experimental in vitro studies suggest that propofol may be toxic to developing neurons. We report the cases of three infants who underwent surgery before 2 months of age for different benign pathologies. Propofol was used for induction and maintenance of anesthesia in all cases. The three patients developed convulsions with similar clinical characteristics (cluster of recurrent clinical and subclinical seizures) between the 23th and 30th hours following anesthesia. Clinical and electroencephalographic improvement was obtained between the third and fourth day of management in pediatric intensive care unit. The seizures never recurred, and the three patients underwent further uneventful general anesthesia without propofol. Follow-up of the three patients disclosed unexpected neurological dysfunction: progressive microcephaly (head circumferences were normal at birth), developmental impairment with cognitive and behavioural disturbances in two cases, and bilateral symmetrical white-matter abnormalities on cerebral magnetic resonance imaging. The causal relationship between propofol anesthesia and the neurological symptoms of our patients remains difficult to ascertain, but we believe that pediatricians, anesthetists and intensive care-givers should be aware of this possible adverse reaction that has never been described before. Copyright © 2009 Elsevier B.V. All rights reserved.
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              Author and article information

              Affiliations
              [1 ]Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Anesthesiology, Children's Hospital, Chongqing Medical University, Chongqing, China.
              Author notes
              [* ]Corresponding author's e-mail address: shushiyu@ 123456hotmail.com
              Contributors
              Journal
              SOR-MED
              ScienceOpen Research
              ScienceOpen
              2199-1006
              06 July 2015
              : 0 (ID: 81998c00-a965-403a-b096-a9dc969dcff1 )
              : 0
              : 1-6
              2876:XE 10.14293/S2199-1006.1.SOR-MED.AXK5RB.v1
              © 2015 Shiyu Shu.

              This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

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