LETTER TO EDITOR
Year : 2012 | Volume
: 6 | Issue : 1 | Page : 89-
Propofol may be useful in patients with congenital dystonia syndrome undergoing magnetic resonance imaging
Tumul Chowdhury, Navdeep Sokhal
Department of Neuroanesthesiology, Neurosciences Center, 7th Floor, All India Institute of Medical Sciences, New Delhi, India
Department of Neuroanesthesiology, Neurosciences Center, 7th Floor, All India Institute of Medical Sciences, New Delhi 110 029
|How to cite this article:|
Chowdhury T, Sokhal N. Propofol may be useful in patients with congenital dystonia syndrome undergoing magnetic resonance imaging.Saudi J Anaesth 2012;6:89-89
|How to cite this URL:|
Chowdhury T, Sokhal N. Propofol may be useful in patients with congenital dystonia syndrome undergoing magnetic resonance imaging. Saudi J Anaesth [serial online] 2012 [cited 2020 Aug 7 ];6:89-89
Available from: http://www.saudija.org/text.asp?2012/6/1/89/93080
Propofol is one of the most common anesthetic drugs used in patients undergoing magnetic resonance imaging (MRI) procedure, especially for neurologic diseases. The concerns of propofol in patients with dystonia are controversial.  Here we reported the beneficial role of propofol in such a condition.
A 6-year-old male child weighing 15 kg came to the department of neurology with complaints of dystonia since birth. The patient was scheduled for MRI brain and upper spine under general anesthesia. On examination, the patient had severe torticolis on the left side (neck completely tilted to left shoulder) and mouth opening was two finger breadths. Other investigations were within normal limits. He was given 0.1 mg glycopyrrolate 1 h prior to MRI. He was shifted to MRI suite. Routine monitors were attached, including pulse oximeter, electrocardiogram, and noninvasive blood pressure. We planned general anesthesia with laryngeal mass airway (LMA) and also kept difficult intubation kit ready. Intravenous line with 22G cannula was established. The patient was induced with intravenous fentanyl 30 μg and propofol 40 mg as incremental boluses without using any muscle relaxation. We noticed gradual disappearance of dystonia and torticolis. After 2-3 min, he was completely relaxed and his neck became straight. After that, we inserted LMA no. 2 without any difficulty. He was maintained with oxygen, nitrous oxide mixture (1:2) and propofol infusion at the rate of 100-200 μg/kg/min. MRI scan was completed within 1 h. At the end of the procedure, infusion of propofol and nitrous oxide was stopped. Trachea was extubated when the patient was fully awake. We followed the patient for 4 h postoperatively. There was no associated dystonia and torticolis observed during this period. The patient was shifted to ward after 6 h.
Propofol has been reported to produce dystonia, opisthotonos, masseter spasm, seizure, and athetosis.  These side effects are attributed to the neurotoxicity phenomenon produced by propofol.  However, most cases occurred in young, female, day-surgery patients during emergence from anesthesia. Propofol is assumed to cause an imbalance of basal ganglia transmitters that produce an increase in excitatory cholinergic output. However, despite numerous case reports, this is the first report of an apparently beneficial role of propofol in a pediatric patient. The dystonia are clinically and genetically different group of disorders with a variety of causes. The major concerns in these patients are difficult positioning, difficult airway, intubation, and postoperative care. Propofol use seems logical in this patient as it has shorter half-life, better recovery profile and in addition, this drug also provides good environment for LMA insertion (blunting of airway reflexes).  More so, the use of propofol infusion eliminates the concurrent administration of muscle relaxant, which is beneficial for better recovery, especially in neurologic patients. The mechanism how it produced the abolishment of dystonic features even in the postoperative period needs further research. However in our opinion, we should use propofol-LMA technique as a first method of choice in pediatric patients with congenital dystonia syndrome undergoing MRI procedure.
|1||Zabani I, Vaghadia H. Refractory dystonia during propofol anaesthesia in a patient with torticollis-dystonia disorder. Can J Anaesth 1996;43:1062-4.|
|2||Islander G, Vinge E. Severe neuroexcitatory symptoms after anaesthesia: With focus on propofol anaesthesia. Acta Anaesthesiol Scand 2000;44:144-9.|
|3||Mc Keating K, Bali IM, Dundee W. The effects of thiopentone and propofol on upper airway integrity. Anaesthesia 1988;43:638-40.|