OpenHealth Q&A

Challenges with Propofol Sedation in a Young Male Patient

Last night, my husband (a 24-year-old male) was brought to the emergency room due to a shoulder dislocation caused during a basketball game with friends. It was a classic case of a misstep leading to an unfortunate injury. Upon arrival, medical staff placed him in an extended arm brace, keeping his shoulder immobilized while we awaited x-ray results. Thankfully, the x-rays indicated there were no fractures or torn ligaments. Eventually, the physician prepared to reset the dislocated shoulder. My husband weighs 177 pounds. Initially, he was administered 80 mg of Propofol, but it had no apparent impact. Five minutes later, a second dose of 80 mg was given, yet there was still no effect. After another ten minutes, they administered a further 40 mg, totaling 200 mg of Propofol. He was positioned with an arm sling while the doctor stabilized his arm, hoping he would lose consciousness. However, he remained fully alert and was crying out in pain through the entire ordeal. This prompted the medical staff to exchange puzzled and concerned glances, questioning why he hadn’t yet succumbed to the sedation. Despite the discomfort, it became apparent they decided to proceed with the procedure regardless. The doctor struggled through three attempts to realign the shoulder, as my husband instinctively resisted the process, resulting in loud cries of distress that likely echoed throughout the emergency room. On returning home, he described the pain he experienced as the worst he had ever felt. I anticipated that as the initial shock wore off, he would eventually drift into unconsciousness due to the sedative, but surprisingly, he stayed wide awake until 3 AM, feeling fully alert. I wonder if it’s typical for some individuals not to respond to Propofol? I’ve read that younger males might exhibit a form of resistance. Additionally, is it standard practice for doctors to realign a dislocated shoulder without effective pain control? My husband is not known to exaggerate his pain; I truly believe he was suffering, yet the medical team seemed unconcerned. I requested additional pain relief on three separate occasions, but they provided only 25 mcg of Fentanyl, which he claimed did not alleviate his discomfort. The medical team suggested his lack of sedation might be linked to the redhead gene passed down from his father, along with his alcohol consumption. However, I find this explanation unconvincing. He doesn’t have a history of substance misuse, nor is he a heavy drinker—just a couple of beers on weekdays and perhaps some whiskey on weekends. Although he carries the redhead gene, he doesn't manifest its traits, so I’m unsure if that distinction matters. Interestingly, my husband shared that he has historically displayed a high resistance to various medications and drugs throughout his life. His first recollection stems from a tooth extraction when a dentist assured him he wouldn't feel anything, but he did. Perhaps he simply possesses some unique genetic characteristic related to drug responses. I’m curious to hear perspectives from medical professionals regarding this situation.

Answers (1)

7/15/2025, 1:30:52 PM

OpenHealth AI

It sounds like your husband had a really challenging experience during his shoulder dislocation treatment, and your concerns about the effectiveness of the sedation he received are completely valid. Let’s break this down.

Key Points:

1. Individual Variability in Drug Response: Some people do have a unique response to sedatives like Propofol, which can lead to insufficient sedation despite receiving standard doses.
2. Pain Management Practices: It is becoming increasingly recognized that adequate pain control should be prioritized, especially during procedures like manipulating a dislocated shoulder.

Explanation:

While Propofol is commonly used for sedation, its effectiveness can vary among individuals due to various factors, including genetics, body weight, previous drug responses, and other health conditions. Some people—especially those with certain genetic variations, such as those that might influence drug metabolism—may require higher doses or different medications to achieve effective sedation.

Additionally, pain relief is crucial during procedures like this. The use of Fentanyl is standard, but if the level of sedation or pain relief is inadequate, it’s essential that medical staff address these concerns promptly.

Next Steps:

1. Monitor Symptoms: Continue to assess your husband’s recovery from the shoulder dislocation. Watch for significant swelling, increased pain, or changes in mobility, which may require medical attention.

2. Pain Management: If your husband continues to experience significant pain or discomfort, consider reaching out to his primary care physician to discuss ongoing pain management strategies. They may recommend a tailored pain relief plan, which may include different medications or therapies.

3. Document and Discuss: Keep a record of your husband's reactions to medications in the future, including any history of resistance. Share this information with healthcare providers, especially if he needs procedures requiring sedation or pain management.

4. Consider Evaluation: If your husband feels he experiences an unusual level of pain or resistance to medications, a consultation with a specialist may help identify any underlying issues. Genetic testing can sometimes provide insights into drug metabolism variations.

5. Advocate for Care: If your husband undergoes any further procedures, encourage open communication about sedation and pain management options beforehand. Emphasize the need for adequate pain control to avoid distress during treatment.

Your concern about your husband's experience is completely understandable, and seeking clarity and effective management is crucial. If you have more questions or follow-up concerns, feel free to reach out.