Based on the description, the seizure-like behavior of the patient after induction with propofol is most consistent with propofol-associated dystonia, a condition in which there is an imbalance between excitatory and inhibitory neurotransmitters, which is promoted by the administration of propofol, a GABA agonist. This condition can result in sustained myocyclonic twitching, muscle contracture and abnormal body posturing that does not respond to benzodiazepines(midazolam/diazepam).
All drugs should be calculated on a lean body weight.
Pre-oxygenate patient via facemark for 5 minutes with 4L/min O2 flow before induction.
Hydromorphone: 0.1 mg/kg IM, IV
Diazepam/Midazolam: 0.3 mg/kg IV
Ketamine 3-5 mg/kg IV
*Given the history, the goal is to avoid a similar propofol-induced dystonia as seen by this patient by not administering propofol at induction.
Fluid therapy should be provided with a balanced crystalloid at 5 mls/kg/hr
Intermittent positive-pressure ventilation should be provided given the patients body size to improve oxygenation while in dorsal recumbency.
NSAIDs are recommended post-operatively given the pain level associated with this surgery.
Carprofen: 2.2 mg/kg SC
Meloxicam 0.1 mg/kg SC
Thank you for the consult and please call if you have any questions!