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  • Propofol Eye Lid Opening Apraxia

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    lakshminivas Pingali
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    The document discusses a phenomenon where patients waking up from propofol sedation are temporarily unable to open their eyelids, known as post-propofol eyelid apraxia. This can mimic unconsciousness but patients are actually awake and able to respond with their extremities. It often leads to misinterpretation if unrecognized, such as being seen as too agitated to extubate or having a severe brain injury. However, with recognition that it will resolve within 20 minutes, it allows for reassurance of the patient and proper management rather than unnecessary interventions. The author encourages checking for command following with extremities to identify this phenomenon in patients emerging from propofol sedation.

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    A rare presentation but very practical,,,!

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    The document discusses a phenomenon where patients waking up from propofol sedation are temporarily unable to open their eyelids, known as post-propofol eyelid apraxia. This can mimic unconsciousness but patients are actually awake and able to respond with their extremities. It often leads to misinterpretation if unrecognized, such as being seen as too agitated to extubate or having a severe brain injury. However, with recognition that it will resolve within 20 minutes, it allows for reassurance of the patient and proper management rather than unnecessary interventions. The author encourages checking for command following with extremities to identify this phenomenon in patients emerging from propofol sedation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    11 views3 pages

    Propofol Eye Lid Opening Apraxia

    Uploaded by

    lakshminivas Pingali
    The document discusses a phenomenon where patients waking up from propofol sedation are temporarily unable to open their eyelids, known as post-propofol eyelid apraxia. This can mimic unconsciousness but patients are actually awake and able to respond with their extremities. It often leads to misinterpretation if unrecognized, such as being seen as too agitated to extubate or having a severe brain injury. However, with recognition that it will resolve within 20 minutes, it allows for reassurance of the patient and proper management rather than unnecessary interventions. The author encourages checking for command following with extremities to identify this phenomenon in patients emerging from propofol sedation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 3

    PulmCrit (EMCrit)

    emcrit.org/pulmcrit/propofol-eye-opening/

    About EMCrit March 20, 2024

    Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from
    non-dominant hemispheric strokes. On superficial examination it will mimic
    unconsciousness, but upon further examination the patient is awake and able to respond to
    stimuli with their extremities.

    I've seen a similar phenomenon of eyelid opening apraxia a few times following
    discontinuation of propofol sedation among intubated patients. Essentially, patients wake up
    from propofol but their ability to open their eyes lags behind the rest of their neurological
    normalization. Over time this will spontaneously resolve.

    Unfortunately, post-propofol eyelid apraxia is often misinterpreted in various ways:

    Patients may appear agitated, because they are disconcerted by being unable to open
    their eyes (as well as the endotracheal tube, of course). This could be misinterpreted
    as being “too agitated to be extubated” – leading to re-sedation and continuation of
    mechanical ventilation.
    Failure to “wake up” promptly off propofol may be interpreted as evidence of a severe
    brain injury (leading to CT scans, neurological consultations, etc.).

    Thus, failure to recognize this phenomenon leads to incorrect management. However, if you
    can recognize it correctly this is really neat, because you can reassure the patient that they
    are fine and within ~20 minutes they will recover and can be extubated.

    After searching a while in the medical literature, I finally found a report of this phenomenon. It
    seems to have been lost in the sands of time, but I think this is describing the same
    phenomenon that I'm seeing: (2297098)

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    So the next time you're having trouble with a patient emerging from propofol sedation, ask
    them to follow commands with their extremities. Maybe you will discover this. Maybe not. But
    I believe that it's out there. I'd be super interested to see if other folks have encountered this
    as well.

    Josh Farkas
    Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical
    Care Medicine at the University of Vermont.
    Social Me

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