title: [Neurological examination in patients undergoing sedation with propofol: a descriptive study].
abstract: BACKGROUND
  The neurological examination is a resource used in evaluating patients who are in coma. Anaesthesia can be a factor that exerts an influence on the findings. We evaluated the examination of the comatose patient in the case of patients anaesthetised with propofol in order to define its clinical value.
  
  
  METHODS
  A prospective study was conducted among those who had undergone heart surgery in the intensive care unit of a tertiary hospital during the months of April and May 2011. Aspects that were analysed were the examination of the anaesthetic coma, pharmacological or medical factors that can have an influence and a full neurological examination following recovery. Patients with previous neurological symptoms were excluded.
  
  
  RESULTS
  Thirty patients were selected (16 males and 14 females); mean age: 72 ± 10 years. All the patients were sedated with propofol. During sedation, 17 (46.7%) presented unreactive pupils. No spontaneous eye movements were observed in 100% of the sample. Ocular alterations in primary position were observed in 23.3% of them. Oculocephalic reflexes were absent in 93.3% and oculovestibular reflexes, in 100%; the corneal reflex, was absent in 70% (with asymmetry), as was the ciliospinal reflex, in 83.3%. The algesic motor response was absent in 93.3%, as were the cutaneous plantar extensor reflexes, in 20%; and 66.7% were indifferent. Following anaesthesia, the neurological examination was normal in 80%, there were slight orientation impairments in 16.7% and a hemispheric syndrome was found in one patient.
  
  
  CONCLUSIONS
  Anaesthesia with propofol alters the reversible cutaneous-plantar, pupillary, trunk and motor response reflexes on withdrawing sedation. The alterations may be asymmetrical. Neurological examinations should not be used in the case of patients sedated with propofol in order to make clinical decisions.
authors.affiliation: Hospital Clinico San Carlos, 28040 Madrid, Espana.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Ordas-Bandera
authors.forename: Carolina
authors.initials: C
authors.lastname: Sanchez-Marcos
authors.forename: David
authors.initials: D
authors.lastname: Janeiro-Lumbreras
authors.forename: M José
authors.initials: MJ
authors.lastname: Jimenez-Martin
authors.forename: Sergio
authors.initials: S
authors.lastname: Muniz-Castrillo
authors.forename: M Luz
authors.initials: ML
authors.lastname: Cuadrado-Perez
authors.forename: Jesús
authors.initials: J
authors.lastname: Porta-Etessam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D003221:Confusion / Q000139:chemically induced; D056805:Consciousness Monitors; D001026:Coronary Artery Bypass; D054810:Deep Sedation / Q000009:adverse effects; D055191:Delayed Emergence from Anesthesia / Q000209:etiology; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D009460:Neurologic Examination; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012021:Reflex, Abnormal / Q000187:drug effects; D012025:Reflex, Pupillary / Q000187:drug effects; D062606:Tertiary Care Centers
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol