Recurrent Generalized Tonic-Clonic Seizures During Emergence from Propofol Target-Controlled Infusion in a Patient...

Seizure-like phenomena (SLPs) associated with propofol have been reported in several publications. The mechanisms underlying these phenomena remain incompletely understood. Some studies suggest that rapid fluctuations in propofol concentration within the brain may contribute to the occurrence of SLPs. Therefore, theoretically, target-controlled infusion (TCI) of propofol, which facilitates the achievement and maintenance of more stable drug concentrations compared to bolus injection or manual infusion, could mitigate the risk of SLP occurrences. However, data regarding SLPs during propofol administration via TCI are limited.

This case describes a 45-year-old female patient with no history of epilepsy or neurological disorders who developed generalized tonic-clonic seizures immediately following the discontinuation of propofol TCI using the Schnider pharmacokinetic model for sedation during gastroscopy and colonoscopy. These seizures recurred after the first two intravenous doses of midazolam; however, after the third seizure was treated with intravenous diazepam, the patient experienced no further seizures.

In addition to further strengthening the evidence regarding rare neurological events associated with propofol, this case suggests that propofol administration via TCI based on the Schnider model may not completely eliminate the risk of drug-induced seizures; thus, anesthesiologists should remain vigilant. Furthermore, the sequential administration of midazolam and diazepam may represent a suitable option for seizure control.