Tolerability of Propofol in WADA Testing (P01.051)

Abstract

Objective:To assess the tolerability of propofol (PF) in Wada test in an Arab population with temporal lobe epilepsy (TLE).Methods:This observational study with consecutive sampling took place in King Fahad Medical City, Riyadh, Saudi Arabia. Nine consecutive patients with mean (+SD) age of 26 (+5.8) years, 6 males and 3 females, underwent Wada test between January 2009 and December 2012. Six of them had left TLE, and 3 had right TLE. Each patient received 10 mg of PF in the internal carotid artery (ICA). Right hemispheric injection was followed by left hemisphere injection after 30 minutes. During the procedure, EEG monitoring showed changes within 5-18 seconds of injection as hemispheric delta slowing. Neuropsychological tests were carried out for localization of memory and language.Results:We were able to lateralize speech dominance in 8 patients and memory dominance in 6 patients. Peri-procedural complications included transient euphoria (n=1), transient spasm of ICA (n=1), eye pain (n=1), facial pain (n=1), and generalized tremulousness (n=2). None of the patients exhibited a symptomatic drop in blood pressure.Conclusions:We found that PF is well tolerable for the Wada test, with minimally significant complications, although blood pressure should be closely monitored.

Experience of adverse events with cerebral propofol testing in patients with drug resistant epilepsy

“…Those studies led to the valance hypothesis stating that the left hemisphere is “positive” and the right hemisphere specializes in negative emotions 27 . In the studies of Curot 13 , Takayama 15 , Alsallom 16 , and Mikuni 17 transient euphoria was observed, and the authors reported this adverse effect after the injection of propofol into both the left and right ICA. The appearance of laughter or euphoria can be explained by disinhibition of the frontal lobe function due to the injection of the anaesthetic or to the propofol molecule 13 .…”

“…Age older than 55 years, a total injection dose of propofol higher than 20 mg and a second injection dose of propofol greater than 10 mg were found to influence the risk of AEs. In another study, Alsallom 16 observed AEs in four of nine patients who were included in the study. AEs were mostly transient; one patient experienced behavioural changes after administering propofol into both ICA, two experienced shivering, and one complained of eye and facial pain.…”

“…This percentage is in line with studies assessing the number of AEs during standard angiography 20–22 . Alsallom 16 reported one serious but not persistent AE related to an angiography procedure; i.e., a segmental ICA spasm, and Loddenkemper 19 noted a case of carotid dissection during the Wada test with amobarbital.…”

Mechanical thrombectomy in a pediatric patient with sedation aided by contralateral intra-arterial propofol injection: feasibility in an extreme condition

“…Intra-arterial administration of propofol was used in the past during the Wada test and is considered a procedure with a safety margin, low incidence of side effects, and can effectively induce a controlled transitory loss of neurological functions [10][11][12].…”