| dc.description.abstract | Acute dystonic reactions have been reported during emergence from anaesthesia following the
use of propofol or/and ondansetron. We present a 37-year-old lady who developed recurrent
and severe involuntary movements and abnormal postures in the upper body during emergence
from anaesthesia following propofol and ondansetron, given as part of a general anaesthetic
for a gynaecological procedure. Reactions were recurrent and severe with associated spells of
severe desaturation. Abnormal movements were reported previously following
metoclopramide (IV). Acute dystonic reactions with associated laryngeal dystonia were
suspected in the context of clinical findings and by exclusion of others. The frequency and
severity of reactions were reduced following benztropine (IM) and midazolam (IV). They were
completely controlled following the second dose of benztropine, which was given two hours
after the first dose. Oxygenation and ventilation were maintained with gentle bag/mask
ventilation during the spells of desaturation. As reported in the literature, Propofol and/or
ondansetron are the most likely causative agent(s) alone or in combination. She made an
uneventful recovery. Evidence for dystonic reactions following propofol and ondansetron is
limited, hence likely to be underdiagnosed and treated empirically with disastrous outcomes.
We alert the anaesthetists and intensivists to use propofol and ondansetron with caution in
patients who reported previous neuroexcitatory phenomena. | en_US |
