Status Epilepticus During Recovery from General Anesthesia

Propofol is an anesthetic agent commonly used for sedation and induction and/or maintenance of general anesthesia and presents an inhibitory effect on the excitatory neurotransmitters through GABA receptors. Although propofol is an agent that can be used to treat status epilepticus because of its anticonvulsant property, it may cause epileptiform convulsions, as reported in the literature. In this case report, a young patient’s epileptiform convulsions after administering a single dose of propofol injection for general anesthesia are presented. Due to uncontrolled epilepsy episodes following extubation, the patient was taken to intensive care. The patient regained consciousness, and epileptic attacks were controlled on the 4th day of intensive, was taken to the neurology service. We consider that this case is noteworthy concerning the association between propofol and epilepsy in anesthesia. Thus, this study aimed to draw attention to propofol in patients with a history of epilepsy.

Clinical biochemistry of epilepsy. II. Observations on two types of epileptiform convulsions induced in rabbits with corticotropin.

We propose than an alarm mechanism is operative in animals, designed to regulate neuromuscular irritability by regulating [Ca2+]. Epinephrine or corticotropin (ACTH), injected intramuscularly into animals, causes a hypercitricemia, resulting in decreased [Ca2+]. This increases muscular excitability to facilitate escape. To avoid over reaction, [Cl-] is shifted into the plasma without a concomitant shift of Na+, thus generating an acidosis and an increase in ionization of Ca. Plasma pH, pCO2, total CO2, and [K+] decrease, and [Mg2+] increases. The acidosis, decrease in K+, and increase in [Mg2+] serve to counteract the effect of the decrease in [Ca2+], to protect against tetany. In the rabbit the hypercitricemia observed upon ACTH administration is accompained by a severe hypocalcemia and drop in blood pressure, resluting in tetanic convulsions. This seems to indicate calcitonin release, independent of the hypercitricemia. Thyroidectomized rabbits show only mild hypocalcemia when given ACTH, but develop a severe acidosis and typical grand mal epileptiform seizures. Administration of ACTH and then calcitonin to the goat, an animal resistant to the effects of ACTH alone, simulates the effect observed in the rabbit with respect to changes in blood components and blood pressure. Changes in the blood in the goat and rabbit resemble those in humans before an epileptic seizure. alpha-Melanotropin, containing a portion of the ACTH sequence, reacts in a manner similar to ACTH but more rapidly.