Paradoxical Agitation and Masseter Spasm During Propofol Procedural Sedation: A Case Report

Area of Science:

• Anesthesiology
• Emergency Medicine

Background:

• Propofol is a common anesthetic for emergency department (ED) procedural sedation.
• It is favored for orthopedic procedures due to muscle relaxation properties.
• Rarely, propofol can cause agitation and muscle hypertonicity.

Observation:

• A case report details a 58-year-old male experiencing agitation during propofol sedation for an ankle fracture-dislocation.
• The patient later developed opisthotonos and masseter spasm, necessitating mechanical ventilation and intubation, attributed to propofol's side effects.

Findings:

• Propofol administration can lead to paradoxical agitation and severe muscle rigidity, including opisthotonos and masseter spasm.
• These reactions, though rare, can mimic seizure-like activity and require immediate medical intervention.

Implications:

• Emergency department physicians should be aware of the potential for propofol-induced agitation and hypertonicity.
• Preparedness for managing these rare but serious adverse events can enhance patient safety during procedural sedation.