title: Diphenhydramine for Acute Extrapyramidal Symptoms After Propofol Administration.
abstract: Extrapyramidal symptoms are an uncommon but well-recognized side effect after the administration of general anesthesia in patients without a significant neurologic history. Several case reports implicate propofol as the likely causative agent producing these symptoms, which include ballismus, dystonia, choreoathetosis, and opisthotonus. Currently, there is no clear consensus on first-line treatment of these symptoms. In each of the published cases, anticholinergic medications and benzodiazepines were central to initial management, although the speed and extent of symptom resolution were variable. Here we present a case of a 17-year-old boy with ulcerative colitis who presented with ballismus, torticollis, tongue thrusting, and oculogyric movements after colonoscopy under general anesthesia with propofol. The patient responded promptly to treatment with diphenhydramine. This is the first reported case in which diphenhydramine was successfully used as the primary treatment of severe extrapyramidal symptoms in a pediatric patient after propofol administration.
authors.affiliation: Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: James
authors.initials: J
authors.lastname: Sherer
authors.affiliation: Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Tomas
authors.initials: T
authors.lastname: Salazar
authors.affiliation: Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Schesing
authors.affiliation: Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Shannon
authors.initials: S
authors.lastname: McPartland
authors.affiliation: Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey j.kornitzer@rutgers.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kornitzer
mesh_terms: D000293:Adolescent; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D003113:Colonoscopy; D004155:Diphenhydramine / Q000627:therapeutic use*; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D015835:Ocular Motility Disorders / Q000139:chemically induced / Q000188:drug therapy; D015742:Propofol / Q000009:adverse effects*; D014103:Torticollis / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D018686:Anesthetics, Intravenous; D018680:Cholinergic Antagonists; D004155:Diphenhydramine; D015742:Propofol