Padaki Amit S, Uppal Prabhdeep, Perza Michael
Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas.
Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware.
Clin Pract Cases Emerg Med. 2024 Nov;8(4):369-371. doi: 10.5811/cpcem.21283.
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.
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.
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.
丙泊酚是急诊科用于程序性镇静的常用麻醉剂。由于其肌肉松弛特性，在骨科手术中常被优先选用。然而，它很少会引起躁动和肌肉张力亢进。
一名58岁男性因左踝关节骨折脱位就诊于急诊科。使用丙泊酚以促进程序性镇静，但患者出现轻度躁动。使用氯胺酮实现完全诱导，之后再次使用丙泊酚以促进肌肉松弛。手术接近尾声时，患者出现角弓反张和咬肌痉挛，并需要球囊面罩通气及随后的插管。这种反应最终归因于丙泊酚的不良反应。
虽然丙泊酚通常耐受性良好，但它可能会引起躁动、张力亢进以及其他副作用，如肌肉痉挛和癫痫样活动。认识并为这些风险做好准备可能会改善患者的预后。
