Low-dose propofol infusion for controlling acute hyperspasticity after withdrawal of intrathecal baclofen therapy

Indications:2 patients with severe spasm secondary to complete C5 injury (case 1) and complete C4 spinal cord lesion (case 2).; Patients:Case 1: One 65-year-old male (in/outpatient). Case 2: One 34-year-old male (in/outpatient).; TypeofStudy:Low-dose propofol infusion for controlling acute hyperspasticity after withdrawal of intrathecal Lioresal therapy was reported. 2 case reports.; DosageDuration:Case 1 (dosage and duration not stated). Case 2: 100 mcg, intrathecally. Duration not stated.; Results:Case 1: The patient had felt increasingly unwell over the previous 24 hours (h), with increasing spasticity and pyrexia. Five hours after admission, the hyperspasticity became more marked, with bilateral clonus and increased abdominal and respiratory, muscle tone despite oral loading with Lioresal. At admission to the critical care unit, arterial blood gas analysis revealed a metabolic acidosis. Propofol was infused at 5-15 mg/h, iv. Within 2 h, the base deficit had normalized, and both the spasms and clonus were markedly reduced. Abdominal and respiratory muscle tone decreased, with the patient feeling settled. The propofol infusion was then continued, preventing the return of hyperspasticity, and stopped 2 days later, during which time a new Lioresal pump was resited surgically. Case 2: Admission 1: After an elective change of intrathecal Lioresal pump, severe hyperspasticity developed within 24 h, accompanied by hyperpyrexia, tachycardia, hypertension, and a respiratory rate of 33 breaths/min. Propofol was infused at 20 -150 mg/h, iv, in addition to 20 mg sublingual nifedipine and 100 mg dantrolene. During the first 5 h of admission, the patient also received Lioresal via a newly introduced intrathecal catheter. Surgical relocation of the catheter was undertaken the next day. Propofol was infused for optimal control of spasms for a further 24 h while intrathecal Lioresal was reintroduced via a newly inserted pump. Admission 2: Two years after admission 1, the patient was admitted with new onset spasms, pyrexia, and respiratory discomfort. Propofol was administered solely, resulting in complete resolution of hyperspasticity, pyrexia, and respiratory rate within 2 h. The spasms resolved after increasing the propofol background infusion (50-150 mg/h). Admission 3: Three year after admission 2, pyrexia and increasingly severe spasms were noted 4 days after the scheduled reimplantation of a new Lioresal pump. Propofol was commenced solely (10 mg/h), with resolution of tachycardia, pyrexia, and spasms within 1.5 h. Propofol was continued for 20 h, over which time pump-delivered Lioresal administration was established. Again, no changes in gas exchange or sedation levels were; AdverseEffects:2 patients experienced withdrawal syndrome (severe hyperspasticity, increased respiratory rate, hyperpyrexia, tachycardia, and hypertension).; FreeText:Case 1: Patient was admitted to the hospital with suspected Lioresal pump failure. Case 2: The patient required intrathecal Lioresal therapy after a complete C4 spinal cord lesion.