Convulsions with propofol during drug-induced sleep endoscopy (DISE)
Authors: Fiorita Antonella, Di Cesare Tiziana, Galli Jacopo, Corina Luigi, Rizzotto Grazia, De Cosmo Germano, Paludetti Gaetano
Background Drug-induced sleep endoscopy (DISE) is a useful method to evaluate multiobstructive sites simulating sleep with drugs; and propofol is the most widely used sedative for this purpose. Different adverse effects have been reported for propofol, including decrease in ventilatory drive and respiratory depression. Several clinical reports have also suggested a possible excitatory effect on the CNS. The supporting electroencephalographic (EEG) evidence is variable; in some cases, where the EEG has been monitored during the administration of propofol, epileptiform activity is not accompanied by motor manifestations, while in other cases, the EEG recordings after the events are reported as normal. Case presentation A 44-year-old male OSA patient, with negative neurological history, had three close episodes of generalized tonic-clonic seizures during DISE few minutes after sedation with increasing doses of propofol. Polygraphic intraoperative recording with EEG monitoring showed the evidence of epileptiform activity. Conclusion The complete polygraphic intraoperative recording during DISE, inclusive of brain electrical function monitoring, allowed us to record the proconvulsive effect of propofol a rare but possible adverse event.
Keywords: DISE, OSAS, Sleep Endoscopy, propofol, convulsions, case report
Authors
Fiorita Antonella
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Di Cesare Tiziana
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Galli Jacopo
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Corina Luigi
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Rizzotto Grazia
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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De Cosmo Germano
Department: Scienze dell'emergenza, anestesiologiche e della rianimazione. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Paludetti Gaetano
Department: “Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo”. Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Correspondence to:
Tiziana Di Cesare, Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy tizianadicesare90@gmail.com
Publication history:
Received 05 May 2020
Accepted 18 May 2020
Published online 25 Jul 2020
Published in print 06 Aug 2020