[Erotic hallucinations associated with the use of propofol]

A 42-year-old woman underwent outpatient surgery to remove vocal cord polyps. She had a history of depressive syndrome and had previously undergone surgery without complications. Before surgery she received 3.5 mg of midazolam orally. General anesthesia was provided with propofol: one initial bolus of 1 mg/kg followed by an infusion of 6 mg/kg/h. Surgery was uneventful. Upon arrival in the postanesthetic recovery ward, the patient, greatly agitated, accused the orderlies pushing the gurney of forcing her to touch his genitals. Twenty-four hours after surgery she did not remember the incident. Since 1987 various cases of postoperative sexual hallucination have been associated with the use of propofol. Usually the patients are women undergoing minor gynecological procedures and involve male health-care providers in the surgical area. The incidents are characteristically followed by amnesia. This clinical picture has also been described for midazolam and nitrous oxide, but the frequency is higher for propofol owing to its pharmacodynamic and pharmacokinetic properties (rapidly recovered awareness and lowering of inhibition). Given the legal implications, the presence of someone of the same sex as the patient is recommended when the patient awakens.