Propofol-Associated Priapism in a Pediatric Patient

Abstract

Objective: To report a case of priapism in an adolescent male following the use of propofol for sedation. Case Report: A 13-year-old male with developmental delay was admitted to intensive care secondary to pneumonia and persistent paroxysmal choreoathetosis. In attempt to stop the choreoathetosis and progressive rhabdomyolysis, he was sedated with 50 mg of intravenous propofol, which successfully resolved the choreoathetosis. Within minutes after the injection, he developed priapism, and within 1 hour it resolved without intervention. Discussion: Priapism was considered to be caused by propofol based on temporal relationship, lack of other medications administered, and complete resolution of symptoms after withdrawal. An objective causality assessment based on the Naranjo adverse drug reaction probability scale suggests propofol is a probable cause of the priapism in our patient. The mechanism of propofol-induced priapism is unknown but likely occurs due to both local and systemic effects. Conclusion: Pediatric clinicians should be aware of this rare side effect, as it requires prompt recognition and potential urologic intervention to alleviate complications.

Propofol-Associated Priapism in a Prepubescent Pediatric Patient

“…The priapism resolved within an hour after aggressive intravenous hydration. 7 Compared with the previously reported case reports, the treatment of our patient’s priapism event was the quickest and least invasive that was accomplished by prompt recognition of the priapism event and discontinuation of propofol, which led to our patient’s erection subsiding within minutes. Also, we monitored our patient very closely for recurrence of the priapism because the longer the priapism persists the higher likelihood that surgery would be necessary for treatment as was seen in the previously mentioned case reports.…”

“…Doherty et al reported that each patient in previous cases of propofol-associated priapism was also on concomitant opioid medication. 7 Similarly, our patient was on a continuous fentanyl infusion. Opioid medications are thought to potentially decrease peripheral vascular resistance, leading to the potentiation of propofol’s effects on inducing priapism.…”

“…6 Also, propofol has been shown to affect nitric oxide-mediated smooth muscle relaxation. 7 Propofol-associated priapism is generally categorized into 2 states based on the penile venous blood flow. 9 Low-flow ischemic priapism, the most common form, is due to occlusion of venous outflow that can be caused by impaired relaxation and paralysis of the cavernosal smooth muscle, vascular stasis, acidosis, and tissue hypoxia.…”

“…We present a case of priapism that occurred in a pediatric patient who was on propofol for sedation in our pediatric intensive care unit (PICU), which was the youngest patient having this rare side effect among a handful of reported cases. 4-7…”

Case Report

“…Within minutes of receiving a propofol injection for choreoathetosis a 13-year-old male developed priapism. No further propofol was administered, the patient received aggressive intravenous hydration and the priapism resolved after approximately 1 hour without further intervention (Doherty & Khandhar, 2015). In Corten et al (2017) case report, the authors can only speculate about the factors responsible for their 48-year-old Caucasian male's prolonged erection lasting approximately 1 day.…”