LETTER TO THE EDITOR
Year : 2011 | Volume
: 27 | Issue : 3 | Page : 418-
Muscle twitching and hiccups with propofol
Department of Anesthesiology, JNMC. DMIMS.D.U., Sawangi, Wardha, Maharashtra, India
Department of Anesthesiology, JNMC. DMIMS.D.U., Sawangi, Wardha- 442 004, Maharashtra
|How to cite this article:|
Khan K. Muscle twitching and hiccups with propofol.J Anaesthesiol Clin Pharmacol 2011;27:418-418
|How to cite this URL:|
Khan K. Muscle twitching and hiccups with propofol. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 Jun 24 ];27:418-418
Available from: http://www.joacp.org/text.asp?2011/27/3/418/83703
Propofol is the most widely used anesthetic agent today in operation theaters and intensive care units. I am reporting a case of severe muscle twitching and continuous hiccups after administration of propofol.
A 30-year-old, 36 kg female was posted for excision biopsy of left breast. Routine preanesthetic check up revealed no abnormality. The patient was shifted to operating room; intravenous line was started; and electrocardiograph, pulse oximetry, and non invasive blood pressure monitoring was instituted. She was premedicated with intravenous glycopyrolate 0.2 mg, midazolam 1 mg, and 1 mg butorphanol. Patient was preoxygenated with 100% oxygen with face mask and anesthesia induced with intravenous propofol 2 mg/kg. Sevoflurane 2% in oxygen was started to deepen the level of anesthesia. Laryngeal mask airway insertion was planned but patient developed severe hiccups and muscle twitching of upper and lower limbs which were uncontrollable. Top up dose of propofol and succinylcholine1 mg/kg were given and trachea intubated with 7 mm ID cuffed endotracheal tube. The procedure lasted for about 45 min and was otherwise uneventful. Recovery was smooth, and no muscle twitching or hiccups were observed. The patient was monitored in recovery room for 2 hours.
Hiccups, muscle twitching, and opisthotonus are known side effects of propofol 1 but are not commonly seen and are possibly due to subcortical glycine antagonism.  Similar effects have been reported earlier, which were relieved by benztropine and were attributed to an imbalance of cholinergic-dopaminergic neurotransmitter in the basal ganglia, as neuromuscular co-ordination involves a fine balance between dopamine receptors (inhibitory) and cholinergic receptors (excitatory). In the patient reported, hiccups and muscle twitching were so severe that succinylcholine was needed to control it and instead of laryngeal mask airway insertion, tracheal intubation was performed.
|1||Morgan Jr GE, Mikhail MS, Murray MJ, Philiplarson Jr C. Clinical Anesthesiology: Non-Volatile Anesthetic agents, propofol. 4 th ed. Tata-McGraw-Hill; 2009. p. 200-2.|
|2||Schramm BM, Orser BA. Dystonic Reaction to Propofol attenuated by Benztropine. Anesth Analg 2002;94:1237-40.|