Iranian Journal of Emergency Medicine

Abstract

Procedural sedation and anesthesia (PSA) is a common practice in the emergency department (ED). We report a case of seizure after ketamine and propofol administration for procedural sedation. Seizure is not a common side effect of ketamine nor propofol. A 60 years old man admitted to the emergency department with complaint of right shoulder pain caused by the blunt trauma. Simple X-Ray revealed anterior dislocation. After administration of 30 mg ketamine and propofol (1:1) intravenously, closed shoulder reduction was performed. After 2 minutes, the patient experienced a generalized tonic-clonic seizure with upward gaze and urinary incontinence. The clonic movements resolved after about 1 minute with supportive care and without anti epilepsy drugs, then the patient entered the post-ictal phase. 45 minutes later, the patient was completely awake and after 6 hours observation, he was sent home with discharge instructions. Seizure is not a common complication of any of the administered drugs. Nevertheless, rare possibilities may also occur, and thus emergency clinicians and others who perform procedural sedation, should be ready for any possible complications to treat them appropriately.