Propofol Myoclonus

Excitatory events following propofol administration are well described. The pathophysiology of these propofol myoclonus movements is not known. The drug should be used cautiously in patients with movement disorders.

Miller’s anesthesia says the following about Propofol Myoclonus –

Induction of anesthesia with propofol is associated with several side effects, including pain on injection, propofol myoclonus , apnea, hypotension, and, rarely, thrombophlebitis of the vein into which propofol is injected.

Pain on injection is less than or equal to that with etomidate, equal to that with methohexital, and greater than that after thiopental.

Pain on injection is reduced by using a large vein, avoiding veins in the dorsum of the hand, and adding lidocaine to the propofol solution or changing the propofol formulation.

Multiple other drugs and distraction techniques have been investigated to reduce the pain on injection of propofol. Pretreatment with a small dose of propofol, opiates, nonsteroidal anti-inflammatory drugs, ketamine, esmolol/metoprolol, magnesium, a flash of light, clonidine/ephedrine combination, dexamethasone, and metoclopramide all have been tested with variable efficacy.

Fospropofol causes less pain on injection, but an equal incidence of tingling/discomfort in the genital areas. Propofol Myoclonus occurs more frequently after propofol than after thiopental, but less frequently than after etomidate or methohexital.

Apnea after induction with propofol is common. The incidence of apnea may be similar to that after thiopental or methohexital; however, propofol produces a greater incidence of apnea lasting longer than 30 seconds. The addition of an opiate increases the incidence of apnea, especially prolonged apnea.

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