Meyer P, Langlois C, Soëte S, Leydet J, Echenne B, Rivier F, Bonafé A, Roubertie A
CHU Montpellier, Service de Neuropédiatrie, Hôpital Gui de Chauliac, Montpellier F-34000, France.
Brain Dev. 2010 Nov;32(10):872-8. doi: 10.1016/j.braindev.2009.11.011. Epub 2010 Jan 8.
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.
丙泊酚是一种广泛用于小儿麻醉诱导和维持的催眠药，具有众所周知的安全特性。体外实验研究表明丙泊酚可能对发育中的神经元有毒性。我们报告了3例2个月龄前因不同良性病变接受手术的婴儿病例。所有病例均使用丙泊酚进行麻醉诱导和维持。这3例患者在麻醉后第23至30小时出现了具有相似临床特征（反复出现临床和亚临床癫痫发作簇）的惊厥。在儿科重症监护病房治疗的第3天至第4天，临床和脑电图有所改善。惊厥未再复发，这3例患者随后在未使用丙泊酚的情况下顺利接受了全身麻醉。对这3例患者的随访发现了意外的神经功能障碍：进行性小头畸形（出生时头围正常），2例出现伴有认知和行为障碍的发育障碍，以及脑磁共振成像显示双侧对称的白质异常。
丙泊酚麻醉与我们患者的神经症状之间的因果关系仍难以确定，但我们认为儿科医生、麻醉师和重症监护人员应意识到这种以前从未描述过的可能的不良反应。
