Occurrence and Care of an Obese Patient During a Serious Adverse Event with Propofol for an Endoscopy Procedure

Propofol is a widely used, short-acting intravenous anesthetic agent which has a barbiturate-like and benzodiazepinelike suppressing effect via the γ-aminobutyric acid A receptor [3]. The favorable characteristics of propofol make it more suitable for unconscious sedation in obese patients [1, 2]. The respiratory depression following propofol administration can happen if propofol is given in a higher dose than needed or in a short period of time and may be avoided with the accurate titration of dosage [1, 2]. On the contrary, SLP represents an unpredictable and insidious adverse event observed mainly during induction of or emergence from sedation or anesthesia with propofol doses ranging between 0.5 and 5.2 mg/kg [3]. The clinical presentation of SLP may be generalized tonic– clonic seizures or twitching and rhythmic movements not perceived as generalized seizures, focal motor seizures, opisthotonos, or involuntary movements. The first two presentations are most suggestive of an epileptic origin [3]. The pathophysiological mechanisms of SLP are complex and involve depression of subcortical centers [3, 4]. At low subanesthetic doses or while it is reaching anesthetic concentrations in the blood and in the brain, propofol may act as proconvulsant by inhibiting inhibitory subcortical centers, resulting in the release of normal hyperexcitability in the cortical ones [4]. At high anesthetic doses, propofol depresses both subcortical and cortical centers, thus acting as an anticonvulsant [4]. The seizures are not caused simply by “too much excitation,” but rather by excitation applied to a mass of neurons which are primed to react to the excitation by going into an oscillatory seizure state [4]. Obesity is rapidly increasing in the Western