Rebounded Response in Propofol Coma Therapy

Abstract

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.