A 27-year-old man with a history of diazepam and midazolam abuse was
admitted to the Department of Psychiatry at Seoul National Hospital with
propofol (2,6-diisopropylphenol) dependence as a result of repeated endoscopic
procedures with propofol sedation. After first receiving propofol for endoscopy
at the age of 24, the patient began visiting endoscopists with growing
frequency with the sole aim of receiving propofol. He underwent endoscopy once
a week in June 2007. In December 2007, he visited seven clinics over a ten-day
period. In July 2008, he underwent endoscopy for 15 consecutive days. The
patient’s propofol abuse continued until he was admitted to the closed
psychiatric wards. He has since been hospitalized seven times for propofol
dependence. The increased seeking behavior that led to the patient’s
uncontrollable desire for propofol is a common pattern in substance
dependence.
Propofol is a widely used sedative hypnotic agent that exerts
ultrarapid activation of special central γ-aminobutyric acid A receptors
[1]. Over 456 000 patients have received propofol
sedation for endoscopy worldwide [2]. A recent US study
showed that 25.7 % of endoscopic procedures involving sedation
utilized propofol in 2006, compared with just 3.1 % in 1989
[3]. Propofol may indeed be an effective sedative with
relatively short recovery times, but its therapeutic window is narrow. Since
the introduction of propofol in the mid 1980 s, 11 reports of propofol
abuse and dependence have surfaced in the medical literature [1]
[4]. Although the addictive
properties of propofol have yet to be proven, case reports suggest a link to
dependence and abuse. Most warnings regarding propofol use, however, focus on
cardiopulmonary complications [5].
This is the first report documenting the case of a patient
repeatedly submitting to endoscopy solely to receive propofol. It highlights
the risks in administering propofol to patients prone to drug abuse.
Gastroenterologists should note that propofol dependence may develop in
patients requesting sedation for repeated endoscopic procedures.
Endoscopy_UCTN_Code_CPL_1AN_2AB
