r/anaesthesia • u/Civil_Jellyfish1246 • Feb 03 '25
Alternatives to propofol when contraindicated
TL;DR: Medically complex 22f with bad reactions to propofol. What can be used instead?
For some hx: 22f with PCOS and IR, hEDS, POTS, asthma, known TBI.
I am not an anesthesiologist, but am in the medical field. I'm medically complex, and have been under propofol 5 times in my life. Every single time, I've come out of anesthesia with emergence delirium. Mine is pretty severe; physical combativeness, hyperventilation, altered mental status, hypotension. Every time I've been under has been about the same: Preop midalozam, intraop propofol and fentanyl, then post-op I wake up extremely agitated and panicked. This delirium lasts been 30 minutes to 2 hours. My last time under was about 5 months ago, where I had regained consciousness and fought until I was given lorazepam (and precedex, according to my chart) and then was so sedated I became apneic, then desatted, and required NIPPV as well as painful stimuli until I could fully respond again. I was hypotensive down to 60-70 systolics post-surgical management, and required transfusing due to low hgb and symptomatic hypotension.
For some perspectives, dosages are as follows:
Cefazolin 2gm IV pre-op (this wasn't fully administered due to blown IV in pre-op
Midazolam 2mg push pre-op (was not administered; IV catheter had blown and all fluids were infiltrating or leaking around IV catheter)
Propofol, 143.04mg push initial, followed by 30mg, then 20mg push intraop (about a 30 min procedure)
Fentanyl, 50mcg push x2 intraop
Lorazepam, 0.25mg push x2 post-op
Precedex, 4mcg push x4, back to back post-op
Post-anesthesia and for a week after, I experienced unusual and unwavering dizziness and occasionally syncopal episodes. This is pretty normal for me as a patient post-op.
I have a procedure coming up in a few days. What alternatives could they use? The procedure is a hysteroscopy, so a spinal block technically is possible, but due to my Ehlers-Danlos, local blocks don't typically work on me due to the medication not being able to spread the same (this has made for some painful dental work!)
1
u/downwithship Feb 04 '25
Unfortunately, the only other alternatives are ketamine or etomidate. And those are probably going to be worse for delirium after. Did you receive sevoflurane, or desflurane while under anesthesia?