During induction with propofol, spontaneous movements can occur without associated epileptiform abnormalities. These movements may include:
Abnormal movements may mimic tonic and clonic movements during seizures, especially during the postoperative period.76 In several cases, cortical epilepsy was activated during electrocorticography, with epileptiform activity beginning 20–30 seconds after a bolus of intravenous propofol.77 Seizures may recur for 7 to 23 days after propofol anesthesia, suggesting a proconvulsant metabolite.78,79
In epilepsy patients who underwent dental procedures, administration of propofol in subanesthetic doses to achieve conscious sedation did not provoke seizures or enhance any interictal epileptiform activity.45
One study showed that administration of calcium chloride minimizes the hemodynamic effects of propofol in patients who undergo coronary artery bypass grafting, and thereafter it may potentially reduce postoperative epileptic paroxysms in these patients.9 Recent studies indicate that the synergetic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting reduces hemodynamic impairment, which is implicated in the pathogenesis of postoperative seizures.83
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
© 2014 Epilepsy.com. All rights reserved.