We treated a patient with Sturge-Weber Syndrome who experienced a postoperative convulsion induced by metoclopramide.
The patient was a 34-year-old woman (height : 153 cm, weight : 50 kg) with right side hemiplegia and mental retardation. She had first experienced convulsions at 3 months of age. Since then, the patient had been treated with an oral anticonvulsant agent and the number of convulsions had been reduced. She had not experienced any convulsions since the age of 15 years. She was diagnosed as having Sturge-Weber Syndrome based on a hemangioma in the right trigeminal Ⅰ and Ⅱ branch region. She had also been diagnosed as having schizophrenia and was taking perospirone orally.
Dental treatment under general anesthesia was planned because of the presence of numerous dental caries and severe periodontal disease requiring tooth extraction. Anesthesia was induced by the inhalation of sevoflurane through a mask and was maintained by the inhalation of desflurane and the intravenous administration of remifentanil. No abnormal events, including convulsions, were observed at the time of the emergence from the anesthesia. Because of post-operative vomiting while the patient was in the ward, 10 mg of metoclopramide were administered through an intravenous line. At 2 h and 40 min after the start of metoclopramide administration, a tetanic convulsion, loss of consciousness, temporary respiratory arrest and cyanosis occurred ; soon after, the patient recovered from the respiratory arrest and consciousness disorder, although the cyanosis persisted. Although she gradually recovered from the convulsions and consciousness disorder, the myoclonic convulsion persisted and she was orally treated with 0.5 g of 50% carbamazepine. Four hours after the first attack, she resumed dietary intake and could walk around the ward. The patient was discharged on the second postoperative day.
Although perioperative stress and the anesthetic agents were both possible causes, the convulsions were most likely induced by the administration of metoclopramide after general anesthesia, even though the convulsions were well controlled using an anti-convulsion agent.
